Etomidate for rapid-sequence intubation in young children: hemodynamic effects and adverse events.
OBJECTIVE
Physicians commonly use etomidate for adult rapid-sequence intubation (RSI), but the manufacturer does not recommend its use for children under 10 years of age due to a lack of data. The authors present their experience with etomidate for pediatric RSI in order to further develop its risk-benefit profile in this age group.


METHODS
Trained abstractors reviewed the medical records for all children under 10 years old who received etomidate for RSI between July 1996 and April 2001.


RESULTS
105 children, with an average age of 3 (+/-2.9) years, received a median dose of 0.32 (+/-0.12) mg/kg of etomidate. The systolic blood pressure increased an average of 4 mm Hg (95% CI = -3.3 to 9.2); the diastolic blood pressure increased 7 mm Hg (95% CI = -3.1 to 11) within 10 minutes of receiving etomidate. The heart rate increased an average of 10 beats/min (95% CI = 4.0 to 17.4). Complications included three patients who vomited within 10 minutes of etomidate administration. There were no cases of documented myoclonus, status epilepticus, or new-onset seizures. Thirty-eight patients received corticosteroids during the hospital course, none for suspected adrenal insufficiency. Three patients died, all from severe brain injury.


CONCLUSIONS
In children less than 10 years old, etomidate seems to produce minimal hemodynamic changes, and appears to have a low risk of clinically important adrenal insufficiency, myoclonus, and status epilepticus. The association between etomidate and emesis (observed in less than 3% of enrolled patients) remains unclear. For clinical situations in which minimal blood pressure changes during RSI are critical, etomidate appears to have a favorable risk-benefit profile for children under 10 years old.
Guldner
Gregory
G
Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA. gguldner@ahs.llumc.edu
Schultz
Jason
J
Sexton
Perry
P
Fortner
Corwyn
C
Richmond
Mark
M
D002675:Child, Preschool; D005045:Etomidate / Q000009:adverse effects / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D007440:Intubation / Q000379:methods*; D014839:Vomiting / Q000209:etiology
D006993:Hypnotics and Sedatives; D005045:Etomidate