The safety of etomidate for emergency rapid sequence intubation of pediatric patients

Objective: To determine whether pediatric patients given etomidate for rapi d sequence intubation (RSI) in the ED develop clinically important hypotens ion or adrenal insufficiency, Methods: Retrospective review of 100 consecutive patients younger than age 10 years given etomidate for RSI in the ED at two academic medical centers. Data were abstracted from ED and in-patient medical records. Clinically im portant hypotension was defined as a decrease in systolic blood pressure (B P) measurement to below one standard deviation (SD) of mean normal for age, Clinically important adrenal insufficiency was defined as the need for exo genous corticosteroid replacement for suspected adrenal insufficiency at an y time during hospitalization. Results: BP measurements before and within 20 minutes after etomidate admin istration for RSI were recorded on 84 intubations (84%). The mean change in BP between pre-intubation and post-intubation measurements was a decrease of I mmHg (95% CI: -6 mmHg to +7 mmHg, P = 0.83). When expressed as a perce ntage of normal BP for age, the mean change in BP was a decrease of 1% (95% CI: -7% to +6%, P = 0.82), Four patients (4.8%; 95% CI: 1.3-11.7%) had a s ystolic BP decrease to below one SD of mean normal for age. Fourteen patien ts received corticosteroids during hospitalisation, but none (0/99, 95% CI: 0-3.7%) for suspected adrenal insufficiency, Conclusions: We found no evidence of clinically important adrenocorticoid s uppression and a low incidence of clinically important hypotension when usi ng etomidate for emergent pediatric RSI, Because other induction agents may also result in hypotension, prospective comparison studies are needed to f urther evaluate the safety of etomidate in this patient population.