European journal of anaesthesiology
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Etomidate is an imidazole-derived hypnotic agent preferentially used for rapid sequence induction of anaesthesia because of its favourable haemodynamic profile. However, 11β-hydroxylase inhibition causes adrenal insufficiency with potentially fatal consequences in specific populations. We review the arguments against the liberal administration of etomidate in critically ill, and especially septic, patients. ⋯ Based on these randomised controlled trials, the use of etomidate should be avoided in unstable trauma patients. Midazolam and ketamine are two valid alternatives with similar intubation and haemodynamic conditions as etomidate but without its adverse effects. Therefore, for safety reasons, etomidate should be avoided in the critical conditions of sepsis and trauma.
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Etomidate is used to induce anaesthesia in critically ill patients in many environments, including pre-hospital care, in the emergency and critical care departments and in the operating theatre. It has a favourable cardiovascular profile, but its use has courted controversy because it suppresses adrenal function which some believe is associated with worse outcome, particularly in patients with sepsis. Because there is much evidence of harm associated with hypotension in critically ill patients, it is important to use an anaesthetic induction drug which is less likely to cause hypotension. ⋯ There is no convincing or consistent evidence that etomidate is associated with harm, particularly if adjustment is made for pre-existing severity of illness. The etomidate debate is currently in clinical equipoise in which there is genuine uncertainty within the expert medical community. We review briefly the arguments in favour of continuing to use etomidate in critically ill patients.
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Editorial Comment
Etomidate for critically ill patients: let us clarify the debate.
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Randomized Controlled Trial
Perioperative pregabalin for acute and chronic pain after abdominal hysterectomy or myomectomy: a randomised controlled trial.
The antiepileptics gabapentin and pregabalin are used as adjuvants to control postoperative pain. ⋯ Pregabalin in the doses given decreased morphine requirements for the first 48 h postoperatively, but neither altered the analgesic requirements beyond 48 h nor had any effect on acute, late or chronic pain.