title: The effect of single dose etomidate during emergency intubation on hemodynamics and adrenal cortex.
abstract: BACKGROUND
  The study aimed to evaluate and compare the effects of a single dose of etomidate and the use of a steroid injection prior to etomidate during rapid sequence intubation on hemodynamics and cortisol levels.
  
  
  METHODS
  Sixty patients were divided into three groups (n=20). Before intubation, and at 4 and 24 hours, blood samples were taken for cortisol measurements and hemodynamic parameters (systolic-diastolic-mean arterial pressure, heart rate), and SOFA scores were recorded. Intubation was achieved with 0.3 mg/kg etomidate IV in Group I, 0.3 mg/kg etomidate following 2 mg/kg methylprednisolone IV in Group II, and 0.15 mg/kg IV midazolam in Group III.
  
  
  RESULTS
  Mean arterial pressure values were lower in Group I at the 24th hour when compared to Groups II and III. In Group I, heart rate values were higher compared to the other Groups. Cortisol levels were lower in Group I at the 4th and at the 24th hour in Groups II and III.
  
  
  CONCLUSIONS
  Administration of methylprednisolone 2-4 minutes prior to etomidate use in emergency situations can prevent adrenal insufficiency in patients undergoing rapid sequence intubation. Moreover, midazolam can be used in low induction doses as an alternative to etomidate.
authors.affiliation: Department of Anesthesiology and Reanimation, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
authors.forename: Güniz
authors.initials: G
authors.lastname: Meyancı Köksal
authors.affiliation: Department of Anesthesiology and Reanimation, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Erbabacan
authors.affiliation: Department of Anesthesiology and Reanimation, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Tunalı
authors.affiliation: Department of Anesthesiology and Reanimation, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
authors.forename: Gülşah
authors.initials: G
authors.lastname: Karaören
authors.affiliation: Department of Biostatistics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
authors.forename: Suphi
authors.initials: S
authors.lastname: Vehid
authors.affiliation: Department of Anesthesiology and Reanimation, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Öz
mesh_terms: D018806:APACHE; D000302:Adrenal Cortex / Q000187:drug effects; D000309:Adrenal Insufficiency / Q000209:etiology / Q000517:prevention & control*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure; D004334:Drug Administration Schedule; D004630:Emergencies; D004638:Emergency Treatment / Q000009:adverse effects*; D005045:Etomidate / Q000008:administration & dosage*; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged
chemical_list: D018686:Anesthetics, Intravenous; D006854:Hydrocortisone; D005045:Etomidate