State of the Art
Etomidate has been used in clinical practice for almost 40 years and a huge experience has been gained. It remains the intravenous hypnotic with the least impact on the cardiovascular system and has been used even in patients with cardiogenic shock. Early set-backs from galenic problems (in particular venous reactions and myocloni) can be largely avoided using relevant techniques and a particular galenic formulation. The blockade of cortisol through etomidate (the “Cortisol-Story”), which in the 1980ies prompted many anaesthetists to abandon the drug, is irrelevant to the use of the drug for a brief period of time. Having also found other properties, not generally recognized, and used these for certain anaesthetic techniques, the author have decided to review relevant issues from the literature.
In studying several hundreds of often contradictory articles for a review, the alternatives are given, either to transfer the confusion or to try to find support for some prominent features personally experienced in clinical use. The author has tried to reflect the existence of controversies where such are found, hoping not to destroy the purpose of this review: yielding a description of a hypnotic with some problematic, but also unique features.
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Last update: October 28, 2012
John Schou, M.D.