Abstract
Objective: To compare the haemodynamic effect of low dose midazolam and etomidate as induction agent in emergency department rapid sequence intubation.
Methods: A prospective observational study in two phases. In phase one, midazolam 2–4 mg was used as induction agent and in phase two, etomidate 0.2–0.3 mg/kg was used. The haemodynamic data were recorded before and after intubation for comparison. Changes in mean systolic blood pressure were analysed with SPSS software.
Results: A 10% decrease in mean systolic blood pressure was observed in the midazolam group (p = 0.001) while there was no significant change in the etomidate group. Some 19.5% of patients had hypotension after being given midazolam while only 3.6% with etomidate (p = 0.002). Patients older than 70 tended to have more hypotension episodes but the difference was not statistically significant.
Conclusions: Midazolam, even in low dose, was more likely than etomidate to cause significant hypotension when used as an induction agent for rapid sequence intubation. Etomidate is a better alternative.
Full Text
The Full Text of this article is available as a PDF (48.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bergen J. M., Smith D. C. A review of etomidate for rapid sequence intubation in the emergency department. J Emerg Med. 1997 Mar-Apr;15(2):221–230. doi: 10.1016/s0736-4679(96)00350-2. [DOI] [PubMed] [Google Scholar]
- Davis D. P., Kimbro T. A., Vilke G. M. The use of midazolam for prehospital rapid-sequence intubation may be associated with a dose-related increase in hypotension. Prehosp Emerg Care. 2001 Apr-Jun;5(2):163–168. doi: 10.1080/10903120190940065. [DOI] [PubMed] [Google Scholar]
- Dufour D. G., Larose D. L., Clement S. C. Rapid sequence intubation in the emergency department. J Emerg Med. 1995 Sep-Oct;13(5):705–710. doi: 10.1016/0736-4679(95)00089-s. [DOI] [PubMed] [Google Scholar]
- Franklin C., Samuel J., Hu T. C. Life-threatening hypotension associated with emergency intubation and the initiation of mechanical ventilation. Am J Emerg Med. 1994 Jul;12(4):425–428. doi: 10.1016/0735-6757(94)90053-1. [DOI] [PubMed] [Google Scholar]
- Li J., Murphy-Lavoie H., Bugas C., Martinez J., Preston C. Complications of emergency intubation with and without paralysis. Am J Emerg Med. 1999 Mar;17(2):141–143. doi: 10.1016/s0735-6757(99)90046-3. [DOI] [PubMed] [Google Scholar]
- Sakles J. C., Laurin E. G., Rantapaa A. A., Panacek E. A. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998 Mar;31(3):325–332. doi: 10.1016/s0196-0644(98)70342-7. [DOI] [PubMed] [Google Scholar]
- Schwartz D. E., Matthay M. A., Cohen N. H. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology. 1995 Feb;82(2):367–376. doi: 10.1097/00000542-199502000-00007. [DOI] [PubMed] [Google Scholar]
- Tayal V. S., Riggs R. W., Marx J. A., Tomaszewski C. A., Schneider R. E. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med. 1999 Jan;6(1):31–37. doi: 10.1111/j.1553-2712.1999.tb00091.x. [DOI] [PubMed] [Google Scholar]