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Etomidate, an imidazole hypnotic, is used as an induction agent in 23 percent of emergency department intubations. Reports of adrenocortical suppression with this agent have caused concern and inhibited its use as a sedative agent in multiple doses or continuous drips. The authors of this study evaluated adrenal suppression after single-dose etomidate for induction in the ED.
In a prospective, randomized, controlled, but nonblinded study, 10 subjects received IV etomidate (0.3 mg/kg) and 8 controls received IV midazolam (0.05-0.10 mg/kg); patients receiving steroids were excluded. Adrenocortical function was assessed by cosyntropin stimulation tests (CST) and serum cortisol measurements at 4 hours, 12 hours, and 24 hours. At the 4-hour CST, …