A comparison of methohexital versus etomidate for endotracheal intubation of critically ill patients.
BACKGROUND
Methohexital has been used for procedural sedation in the emergency department, but its use for endotracheal intubation in intensive care units has not been studied.


OBJECTIVE
To compare methohexital with etomidate with respect to their effectiveness and safety of use for endotracheal intubation in the intensive care unit.


METHODS
Retrospective, observational, single-center cohort study of consecutive patients admitted between December 2006 and August 2007 to a medical intensive care unit in a tertiary-care hospital.


RESULTS
Twenty-three patients who received methohexital and 23 who received etomidate for endotracheal intubation were included. The 2 groups differed in age (mean [SD], 55 [13] vs 64 [13] years, P = .03) but not in baseline demographics or illness severity scores. Mean (SD) doses given were 1 (0.2) mg/kg for methohexital and 0.2 (0.1) mg/kg for etomidate. Use of midazolam, fentanyl, and succinylcholine was similar between the groups. Rates of successful intubation after 1 attempt (78% vs 83%), time to successful intubation (mean, 5.9 vs 4 minutes), and number of intubation attempts (mean, 1.5 vs 1.2) also were similar. Change in hemodynamics (delta systolic blood pressure), vasopressor requirements, and amount of fluid resuscitation (normal saline) did not differ significantly between the groups.


CONCLUSIONS
Rates of successful intubation are similar with etomidate and methohexital. Methohexital provides adequate sedation and could be an alternative to etomidate, although both agents were often associated with development of hypotension. Prospective studies are needed to establish the safety of methohexital use in intensive care patients.
Diaz-Guzman
Enrique
E
University of Kentucky, Veterans Affairs Hospital of Lexington, Kentucky, USA. enriquedgz@uky.edu
Mireles-Cabodevila
Eduardo
E
Heresi
Gustavo A
GA
Bauer
Seth R
SR
Arroliga
Alejandro C
AC
D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D016638:Critical Illness; D005045:Etomidate / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008723:Methohexital / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D008723:Methohexital; D005045:Etomidate