Etomidate for critically ill patients. Pro: yes we can use it.

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. Etomidate undoubtedly causes adrenal suppression, but the clinical consequences of this remain unclear. 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.