Etomidate Versus Ketamine, Disaster Triage

Abstract

Multiple papers have been reviewed in this column recently indicating that even single doses of etomidate may have detrimental effects on adrenal function of patients undergoing rapid sequence intubation (RSI). Although there is no absolutely definitive evidence on this matter and the jury is still out, whether at some point etomidate goes away as an option for sedation for RSI is problematic. There are few alternatives for sedation that do not have negative hemodynamic effects and are of short duration. This paper looks at the possibility of using ketamine as an alternative for etomidate; 655 patients needing RSI were randomized to either single-dose etomidate or single-dose ketamine for sedation in a blinded fashion. After exclusions, 234 patients remained in the etomidate group, and there were 235 patients in the ketamine group. The findings indicate no significant differences in multiple aspects of the patient status between single-dose etomidate and single-dose ketamine. There was no significant difference in morbidity or mortality, duration of catecholamine administration, duration of being on mechanical ventilation, or length of stay in the intensive care unit. There were no serious adverse events with either drug.