Etomidate for Procedural Sedation in the Emergency Department

Samuel M. Keim, MD, Brian L. Erstad, PharmD, FCCM, John C. Sakles, MD, Virgil Davis, MD


Pharmacotherapy. 2002;22(5) 

In This Article


Table 1 lists indications for administration of etomidate for sedation; Table 2 contains demographic and drug administration information for the 48 patients in the study. All but two of the patients were adults; two were children -- a 6-year-old and a 9-year-old who were sedated for reduction of fracture and paraphimosis, respectively. Excluding these two patients from dosing and time calculations led to no differences in means or standard deviations. Recovery times for eight patients were incomplete and thus were not reported. Overall, 30 emergency department physicians were involved in the sedation procedures.

A total of 10 (21%) patients experienced adverse events associated with etomidate sedation Table 3 ). None of these had a poor outcome as indicated by need for intubation, prolonged emergency department stay, or hospital admission. One (2%) patient had transient apnea and one (2%) had desaturation; one required bag valve mask ventilation and the other a nonrebreather mask. Both had been given opioids before receiving etomidate; neither suffered any complications. Two (4%) patients experienced emesis -- one while sedated, the other during recovery from sedation. Neither had fasted for more than 2 hours, and neither experienced aspiration. The two (4%) patients who had emergence anxiety did not require additional drugs.

Procedures failed for four (8%) patients. Three had hip dislocations, two of which were reduced in the operating room; the third was reduced in the emergency department while the patient was sedated, but at a point unknown relative to the etomidate dose. The fourth patient had a temporomandibular joint dislocation that was later reduced with fentanyl and midazolam. No physicians or charts indicated that the etomidate sedation appeared inadequate. Patients were observed in the emergency department for an average of 117 minutes after etomidate administration. All were discharged from the emergency department except for the two who underwent general anesthesia for reduction of hip dislocation.