Etomidate for Procedural Sedation in the Emergency Department

STUDY OBJECTIVE: To review our experience with etomidate in nonintubated patients in the emergency department. DESIGN: A 2-year retrospective chart review of consecutive patients receiving etomidate for sedation. SETTING: Emergency department of a university-based teaching hospital. PATIENTS: Forty-eight patients who underwent painful procedures in the emergency department. MEASUREMENTS AND MAIN RESULTS: Demographics, dosing information, recovery times, and adverse events were abstracted using a standardized data collection form. Forty-eight nonintubated patients were sedated with etomidate. Mean age was 34 years (range 6-80 yrs); 38 were men and 10 women; two were children. The mean initial dose of etomidate was 13 mg. Adverse events occurred in 11 (21%) patients. None sustained any substantial morbidity as indicated by need for intubation, prolonged emergency department stay, or hospital admission. CONCLUSION: Although controversial, etomidate holds promise as a potent sedative agent for patients undergoing painful procedures in the emergency department. A large prospective evaluation is needed to document the performance and complications of this agent.