Original ContributionEtomidate for procedural sedation in the elderly: a retrospective comparison between age groups☆,☆☆
Introduction
Etomidate has become an important tool in the arsenal of today's emergency physician. It is being used in a variety of scenarios for both intubation and procedural sedation. Physicians enjoy its quick onset and short duration of action along with the minimal hemodynamic effects. It has been shown to be superior to midazolam not only in causing significantly fewer episodes of hypotension when used as an induction agent in rapid sequence intubation [1], but also in procedural sedation and analgesia when used for anterior shoulder dislocations [2]. Etomidate has been deemed an appropriate agent for procedural sedation in the emergency department [ED] [3].
As with any drug, however, etomidate is not without its adverse effects. Etomidate significantly increased mortality rates of ICU trauma patients when it was used as a continuous infusion for sedation [4]. Despite inhibition of the adrenal mitochondrial hydroxylase activity, frank adrenal suppression has long been debated; and multiple articles have discussed the possible detrimental effects etomidate can have in patients in septic shock [5], [6], [7], [8]. The adrenal effects remain unclear even after a single dose of etomidate [9], [10]. Other adverse effects that have been reported are apnea, emesis, desaturation, myoclonus, bradycardia, and emergency anxiety [11], [12], [13], [14].
Etomidate for procedural sedation has become a common drug among emergency physicians because of its relatively safe adverse effect profile. It has been used in all age groups with success. With the appearance of an ever-increasing number of elderly patients in the ED, emergency physicians must be careful with their use of sedatives and analgesics. It is the goal of this study to compare the adverse effects and length of stay (LOS) between the elderly population (65 years and older) and the general adult population (18-64 years old) when etomidate is used for procedural sedation. Specifically, our hypothesis is that using etomidate in the elderly population does not lead to more adverse effects or a longer LOS in the ED.
Section snippets
Methods
We performed a 4-year retrospective analysis of ED patients who received etomidate for procedural sedation from June 1, 2004, to June 16, 2008. The ED is an urban setting teaching hospital on the north side of Chicago with an annual ED volume of 55 000 patients.
We used electronic medical records to select all patients who received etomidate in the ED over the time frame. Because the study design focused only on procedural sedation of adults, all patients younger than 18 years and those who
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Cited by (11)
Pain Management for Orthopedic Injuries
2020, Emergency Medicine Clinics of North AmericaCitation Excerpt :Compared with other sedatives, it causes similar respiratory depression but has improved hemodynamic stability. Etomidate is used in the ED for procedural sedation because of its low rate of reported complications (10%–15% overall) and rapid recovery to patient baseline.41–45 Of note, although this figure may seem high, it includes all complications, even those that are minor, including prolonged sedation, snoring, and mild changes in oxygenation (90%–95%) requiring supplemental oxygen.
Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department
2014, Annals of Emergency MedicineCitation Excerpt :Key words/phrases for literature searches: ketamine, propofol, etomidate, dexmedetomidine, remifentanil, fentanyl, adverse events, procedural sedation, conscious sedation, deep sedation, and variations and combinations of the key words/phrases; years January 2004 to May 2012. During recent years, there has been a continuously growing body of evidence addressing ketamine, midazolam, fentanyl, propofol, and etomidate that significantly adds to the depth of understanding of these agents' use in the ED.1,11-20,30,39,43,58,61-88 The use of short-acting sedative agents such as propofol and etomidate for ED procedural sedation and analgesia has gained widespread acceptance.
Emergency airway management in geriatric and younger patients: Analysis of a multicenter prospective observational study
2013, American Journal of Emergency MedicineCitation Excerpt :Aging brings a number of physiologic changes that affect respiratory and cardiovascular function and which may complicate airway management. There are several reports about drug use with intubation for geriatric patients, but most of them are perioperative studies within single institutions[4-10]. To our knowledge, there are no multicenter prospective studies investigating emergency airway management for geriatric patients.
Emerging Anesthetic Nanomedicines: Current State and Challenges
2023, International Journal of NanomedicineAnesthesia and perioperative management of elderly patients with severe burns
2020, Chinese Journal of AnesthesiologyProcedural sedation and analgesia in trauma
2019, The Emergency Medicine Trauma Handbook
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Oral presentation was given at the 2009 American College of Osteopathic Emergency Physicians Fall Scientific Assembly in Boston, MA, September 30, 2009.
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Poster presentation was given at the 2010 Illinois College of Emergency Physicians Spring Symposium at Northwestern Memorial Hospital, Chicago, IL, April 29, 2010.