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Studies of the use of single-dose etomidate in rapid sequence intubation (RSI) have demonstrated transient suppression of the adrenal response to exogenously administered adrenocorticotropic hormone and suppression of serum cortisol (but not to a level below the normal range). In a prospective, unblinded randomized study, researchers compared the adrenal effects of two RSI protocols: etomidate (0.3 mg/kg) plus succinylcholine (1 mg/kg) versus fentanyl (100 µg) plus midazolam (5 mg) and succinylcholine (1 mg/kg). During a 7-month period at a single level I trauma center, 30 of 61 patients who met inclusion criteria were randomized to one of the two protocols.
Mean serum cortisol levels at 4 to 6 hours after RSI were significantly lower in the…