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Ketamine Is a Safe Alternative Sedative to Etomidate When Intubating Critically Ill Patients NEW YORK -- June 30, 2009 -- Ketamine is a safe and valuable alternative to conventional etomidate to use as a sedative during intubation of critically ill patients, according to a study published online first and in an upcoming edition of The Lancet. Previous studies have suggested that etomidate could be associated with increased mortality in patients with sepsis. Frederic Adnet, Hôpitaux de Paris, Paris, France, and colleagues conducted a randomised controlled trial of 655 patients who needed emergency intubation. Patients were enrolled from 12 emergency departments and 65 intensive care units in France. Patients received either etomidate 0.3 mg/kg (n = 328) or ketamine 2 mg/kg (n = 327). The endpoint of the trial was the maximum score of the sequential organ failure assessment (SOFA). Patients who died before reaching hospital or discharged from intensive care within 3 days were excluded. A total of 234 patients were analysed in the etomidate group and 235 in the ketamine group. The mean maximum SOFA score did not differ significantly between the 2 groups (10.3 for etomidate, 9.6 for ketamine). The difficulty of intubation also did not differ significantly between groups. However, adrenal insufficiency occurred in 86% of patients given etomidate, compared with just 48% of those given ketamine. The authors said the occurrence of adrenal insufficiency in the ketamine group was probably due to other causes than just the sedative agent used. “Our results show that ketamine is a safe and valuable alternative to etomidate for endotracheal intubation in critically ill patients, and should be considered in those with sepsis.” SOURCE: The Lancet E-mail this page to a friend or colleague! To print, use this version