tailieunhanh - Báo cáo khoa học: " Etomidate, sepsis, and adrenal function: not as bad as we thought"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Etomidate, sepsis, and adrenal function: not as bad as we thought? | Available online http content 11 3 145 Commentary Etomidate sepsis and adrenal function not as bad as we thought Ryan Kamp and John P Kress University of Chicago Hospitals S Maryland Avenue Chicago Illinois 60637 USA Corresponding author John P Kress jkress@ Published 28 June 2007 This article is online at http content 11 3 145 2007 BioMed Central Ltd Critical Care 2007 11 145 doi cc5939 See related research by Ray and McKeown http content 11 3 R56 Abstract The choice of induction agent for endotracheal intubation can have significant downstream effects especially in critically ill patients. In a retrospective study Ray and McKeown found that the choice of induction agent had no significant effect on use of vasoactive medications corticosteroids or mortality. Given the heated debate regarding corticosteroids in septic shock and the role that etomidate may play in leading to adrenal insufficiency enthusiasm for etomidate as an induction agent should be tempered by its possible significant side effects in these critically ill patients. The period of induction of anesthesia in patients with sepsis continues to carry inherent risk for further compromise in these critically ill individuals. Extreme caution must be exercised in choosing an induction agent to perform endotracheal intubation in these unstable patients. In this issue of Critical Care Ray and McKeown 1 report a retrospective review in which they examine the influence of induction agent on further utilization of vasoactive medications corticosteroids and mortality with a particular focus on etomidate. Etomidate is known to cause adrenal suppression both after a single dose and with prolonged infusion 2 3 . The clinical significance of this drug effect continues to be debated but etomidate does not carry the significant acute hemodynamic effects of other induction agents 4 . This makes it a common choice to facilitate endotracheal intubation

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