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Highly Accessed Review

Pro/con debate: Is etomidate safe in hemodynamically unstable critically ill patients?

Gordon Flynn1 and Yahya Shehabi2*

Author Affiliations

1 Department of Intensive Care Medicine, Prince of Wales Hospital, Randwick, NSW, 2031 Australia

2 University of New South Wales Clinical School, Intensive Care Research, Prince of Wales Hospital, Randwick, NSW, 2031 Australia

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Critical Care 2012, 16:227  doi:10.1186/cc11242

Published: 19 July 2012

Abstract

Etomidate is an induction agent known for its smooth intubating conditions and cardiovascular stability. Studies, however, have shown that a single dose of etomidate can result in a prolonged adrenal insufficiency. The impact of this in patients with sepsis has been a matter for debate. This review presents a pro/con case for using etomidate in hemodynamically unstable critically ill patients and provides guidance for alternative induction techniques and when the use of etomidate might be justified despite these concerns.