Etomidato en el manejo emergente de la vía aérea: el fundamento de la controversia

Etomidate for the airway management of patients with dysfunctional cardiovascular and/or neurological systems has been a subject of debate due to its inhibitory effect on the adrenal response to stress. There are questions about the certainty of the effect of single-dose etomidate on adrenal steroidogenesis, its impact on mortality, and other clinical outcomes, including the role of concomitant use of steroids. A non-structured search was performed in MEDLINE and SciELO databases. Conclusions are that single-dose etomidate does decrease serum cortisol levels, with the maximum effect occurring during the first 1-4 hours, and its use seems not to have any effect on mortality. It also appears to have no impact on ICU length of stay, or other clinical outcomes. However, there are no controlled trials with sufficient individual power to demonstrate these findings. Finally, there is not enough evidence to contraindicate its use, so it is still an attractive pharmacological alternative in emergency settings.