mssmem.com

I forget…what did that email say? oh yeah, its at mssmem.com

Airway Management of the Septic Patient

Very Abbreviated conversation between Matt Denny and Scott Weingart:

Matt: I’ve been reading a few articles arguing against using etomidate, even as a single dose for induction, on the grounds that it suppresses cortisone production. The alternatives were giving steroids to all such patients post etomidate, or using alternative agents such as thiopental or dexmedetomidine. What’s your take on all of this?

Scott: dex not a good induction agent. thoipental induces hypotension, so you must dose accordingly. i use ketamine for my sepsis inductions. etomidate is fine if the patient is going to get empiric steroids anyway, i.e. your patient already on vasopressors. etomidate may result in a patient getting placed on pressors a few hours earlier than they would without it. does this have clinical relevance now that we supplement all patients on pressors, who knows. It is a confounder for all of Annane’s work on the value of steroids in septic shock.

Etomidate in Sepsis:
http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:15764790

Written by phil

May 30th, 2006 at 8:02 pm

Posted in Pearls