Baird C R W, Hay A W, McKeown D W, Ray D C
Department of Anaesthesia, Royal Infirmary, Edinburgh, UK.
Emerg Med J. 2009 Aug;26(8):576-9. doi: 10.1136/emj.2008.067801.
Etomidate is used widely for rapid sequence induction (RSI) of anaesthesia in the emergency department (ED) as a result of its relative cardiovascular stability. There is concern over possible adrenal suppression and also that outcomes could be worse than in patients given other induction drugs. This possible association has not been studied in ED patients undergoing RSI.
525 consecutive patients who underwent RSI in the ED and were subsequently admitted to an intensive care unit (ICU) were reviewed. The following information was retrieved from the records: induction drug use; incidence of hypotension and vasopressor administration at induction; acute physiology and chronic health evaluation (APACHE) II severity of illness and predicted mortality; and ICU and hospital outcome. The choice of induction drug was not controlled but was at the discretion of the attending clinicians.
The numbers of patients given an induction drug were 184 etomidate, 306 thiopental and 35 propofol. Patients given etomidate were older and sicker than those given thiopental or propofol. Mortality appeared greater with etomidate but there was no difference when outcome was related to pre-existing risk. Age, APACHE II score and presenting diagnosis were independent predictors of hospital mortality, but etomidate use was not.
Induction drug was not related to patient outcome in this cohort of patients. The risks of developing hypotension and receiving a vasopressor at induction were greatest with propofol. Emergency physicians should choose an induction drug based on individual patient circumstances, rather than being solely concerned about adrenal suppression.
依托咪酯因其相对的心血管稳定性，在急诊科（ED）被广泛用于麻醉快速顺序诱导（RSI）。人们担心其可能导致肾上腺抑制，并且其效果可能比使用其他诱导药物的患者更差。这种可能的关联尚未在接受RSI的ED患者中进行研究。
回顾了525例在ED接受RSI并随后入住重症监护病房（ICU）的连续患者。从记录中获取以下信息：诱导药物的使用；诱导时低血压的发生率和血管升压药的使用情况；急性生理学与慢性健康状况评估（APACHE）II疾病严重程度和预测死亡率；以及ICU和医院结局。诱导药物的选择未受控制，由主治医生自行决定。
接受诱导药物的患者人数分别为184例使用依托咪酯、306例使用硫喷妥钠和35例使用丙泊酚。使用依托咪酯的患者比使用硫喷妥钠或丙泊酚的患者年龄更大且病情更严重。依托咪酯组的死亡率似乎更高，但与既往风险相关的结局并无差异。年龄、APACHE II评分和就诊诊断是医院死亡率的独立预测因素，但依托咪酯的使用并非如此。
在这组患者中，诱导药物与患者结局无关。诱导时发生低血压和接受血管升压药的风险在丙泊酚组中最高。急诊医生应根据患者个体情况选择诱导药物，而不仅仅是担心肾上腺抑制。
