Re: Sedation vs. sedation/paralysis

[Rick Cosmar <crescue@brawal.com>]

Allan,

Unfortunately we have not seen the same results with Etomidate.  In my 
experience I have found it to be unreliable as a lone sedative for 
intubation. Approximately 30 intubations thus far this year and have 
witnessed Etomidate as the lone agent work 2 times.  We have found that 
when a patient is combative/CHI they clinch down. It has been our 
practice to have all RSI drugs ready. Usually the next is Anectine then 
confirmation of ETT via ET Co2 (easy cap) then capnography as well as 
auscultation. Then Norcuron to finish off RSI.  I seems that the 
majority patients tend to clinch down after being given Etomidate.

It has only been somewhat reliable with cardiac pts.  It is our MCP 
recommendation to use it with CHI and cardiac due to its beneficial 
effects on decreased ICP and cardiac workload. But the majority of the 
time we have been getting the job done with Versed / Anectine / 
Norcuron. I do agree that Versed can also be unpredictable with it's 
ability to sedate. But not as often as Etomidate. We also realized that 
Etomidate was not designed as a stand alone sedative agent for RSI.

As for continued sedation we pretty much exclusively use Versed. 
Etomidate at 0.3/kg is not written into our orders as a follow up 
sedative to transport. Pretty much use it one time and if the desired 
result  is not obtained then follow it up with the standard RSI drugs. I 
know there is a positive benefit from giving Etomidate but it seems it 
just doesn't produce the same or as often as Versed.  I often wonder if 
our dosage could be increased to obtain the same results you are getting??

Rick Cosmar
Medflight of Ohio


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