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Midazolam is more likely to cause hypotension than etomidate in emergency department rapid sequence intubation
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  1. Y F Choi,
  2. T W Wong,
  3. C C Lau
  1. Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
  1. Correspondence to:
 Dr Y F Choi
 Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Hong Kong SAR; choiyfnetvigator.com

Abstract

Objective: To compare the haemodynamic effect of low dose midazolam and etomidate as induction agent in emergency department rapid sequence intubation.

Methods: A prospective observational study in two phases. In phase one, midazolam 2–4 mg was used as induction agent and in phase two, etomidate 0.2–0.3 mg/kg was used. The haemodynamic data were recorded before and after intubation for comparison. Changes in mean systolic blood pressure were analysed with SPSS software.

Results: A 10% decrease in mean systolic blood pressure was observed in the midazolam group (p = 0.001) while there was no significant change in the etomidate group. Some 19.5% of patients had hypotension after being given midazolam while only 3.6% with etomidate (p = 0.002). Patients older than 70 tended to have more hypotension episodes but the difference was not statistically significant.

Conclusions: Midazolam, even in low dose, was more likely than etomidate to cause significant hypotension when used as an induction agent for rapid sequence intubation. Etomidate is a better alternative.

  • RSI, rapid sequence intubation
  • SBP, systolic blood pressure
  • etomidate
  • hypotension
  • midazolam
  • rapid sequence intubation

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Footnotes

  • Funding: none.

  • Conflicts of interest: none declared.

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