Special Report: Should Etomidate Be Used as an Induction Agent for Patients with Sepsis?

Introduction

Etomidate is the most commonly used induction agent in the U.S., and it has gained popularity in Canada.1,2,3 However, recent debate about its safety in patients with sepsis has centered around a potential association with adrenal insufficiency.4,5,6,7,8 In this special report, we discuss the rationale for etomidate’s high utilization, the origins of the debate about adrenal insufficiency, and the current literature regarding the safety of a one-time dose of etomidate in emergency rapid sequence intubation (RSI).

Background

Used since 1972, etomidate is an imidazole with hypnotic effects that are thought to be induced through the γ-aminobutyric acid (GABA) adrenergic system.9,10 An estimated 80% of U.S. emergency physicians use et…