Thanks to one of our followers for the next question:
I am have been hearing many of my colleagues concerned about the potential harm created by adrenal suppression secondary to Etomidate use, especially in septic patients. A recent meta-analysis [Chan, C. et al Etomidate is associated with mortality and adrenal insufficiency in sepsis: A meta-analysis. Critical Care Medicine 2012 Nov;40(11):2945-53] found an association between Etomidate and increased mortality. I have two questions to ask:
1. Should I stop using Etomidate during RSI and switch to Ketamine?
2. Is there literature to support the use of Ketamine during RSI in patients with suspected increased intra-cranial pressure or intra-occular pressure?
So, what do you all think?