The effect of etomidate on intracranial pressure and systemic blood pressure in pediatric patients with severe traumatic brain injury.
OBJECTIVE
To evaluate the effects of single-dose etomidate in pediatric patients with intracranial hypertension after severe traumatic brain injury.


METHODS
Patients admitted to the pediatric intensive care unit with severe traumatic brain injury were enrolled with the informed consent of their guardians. The experimental intervention was a single dose of etomidate 0.3 mg/kg intravenously. This dosage was administered only when enrolled patients had acute elevations of intracranial pressure (ICP) to over 20 mm Hg for over 5 minutes. ICP and mean arterial pressure (MAP) were monitored continuously. ICP and MAP values for 6 consecutive 5-minute intervals after etomidate administration were averaged for all patients and compared with baseline.


RESULTS
Eight patients were enrolled. Mean ICP after etomidate administration was significantly lower than baseline ICP for each 5-minute interval (P < 0.05). The mean MAP for all patients increased from baseline during the first 5-minute interval, but this change was not statistically significant. No patient's MAP decreased below baseline at any time point.


CONCLUSIONS
In pediatric patients with severe traumatic brain injury, single-dose etomidate administration resulted in statistically significant reductions in ICP and improvement in cerebral perfusion pressure without significantly altering MAP.
Pediatric Emergency Medicine, St Luke's Regional Medical Center, Boise, ID, USA. kbramwell@emidaho.com
Kenneth J
KJ
Bramwell
Julie
J
Haizlip
Chuck
C
Pribble
T Chad
TC
VanDerHeyden
Madolin
M
Witte
D000293:Adolescent; D001794:Blood Pressure / Q000187:drug effects*; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology*; D002648:Child; D005045:Etomidate / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D015601:Injury Severity Score; D019586:Intracranial Hypertension / Q000209:etiology*; D007427:Intracranial Pressure / Q000187:drug effects*; D008297:Male
D006993:Hypnotics and Sedatives; D005045:Etomidate