Looks Like Someone Finally Found A Good Use For Etomidate

[Gern Blansten]

I think the main issue with botched executions is lack of a good and functional IV, not the drug choices. Many of the people who start the IV's are not skilled at it. Perhaps they need to use IO's. Any of us on this forum could come up with 100 or more good drug combinations that would work just fine and be aesthetically pleasing if they were delivered through a functional IV.
Perhaps diazepam 100 mg po followed 20 minutes later by nitrous oxide for 5 minutes followed by adding halothane 8% for 10 minutes then carbon monoxide for 15 minutes. Take the IV out of the equation completely.

---

Members don't see this ad.

 

[leaverus]

I think I used etomidate 3 or 4 times total my entire fellowship year. When an attending told me to. Same sick population of cardiac cripples.

I just ... don't see any place for it in the OR. Those patients who are truly on the edge of their reserve go to sleep just fine with a bit of midazolam, 0-20 of propofol, and a whiff of gas. Sometimes a little ketamine. I genuinely can't think of a single case where I would want to use it.

that's odd. I must be a worse clinician than my crnas who seem to find at least one or two pts a week that need it.

 

[hankbb02]

I think I used etomidate 3 or 4 times total my entire fellowship year. When an attending told me to. Same sick population of cardiac cripples.

I just ... don't see any place for it in the OR. Those patients who are truly on the edge of their reserve go to sleep just fine with a bit of midazolam, 0-20 of propofol, and a whiff of gas. Sometimes a little ketamine. I genuinely can't think of a single case where I would want to use it.

It's funny how institutional culture influences induction drugs of choice. During my residency, everyone used propofol for induction. Etomidate was the worst drug known to human kind. The cardiac cripples were induces in the manner you describe and I learned out to do a stable induction on a sick cardiac patient using a balanced technique with low dose propofol. In my cardiac fellowship everyone gets etomidate. The first couple of weeks I was drawing up propofol and my staff thought I was crazy. Some of them even induce easy non-CT cases with it, read lap heller myotomy.

I spent a decent amount of time reviewing the literature after starting fellowship and came to realize that outcomes in septic patients were no different. It doesn't even matter if you stress dose them, no impact on clinical outcomes.

 

[lord_jeebus]

I think the main issue with botched executions is lack of a good and functional IV, not the drug choices. Many of the people who start the IV's are not skilled at it. Perhaps they need to use IO's. Any of us on this forum could come up with 100 or more good drug combinations that would work just fine and be aesthetically pleasing if they were delivered through a functional IV.
Perhaps diazepam 100 mg po followed 20 minutes later by nitrous oxide for 5 minutes followed by adding halothane 8% for 10 minutes then carbon monoxide for 15 minutes. Take the IV out of the equation completely.

100% Xenon.

 

[dhb]

100% Xenon.

Too expensive, Gern has a sweet combo

 

[lord_jeebus]

Xenon is too expensive for routine OR anesthesia, but execution is quick and rare. I read somewhere that it's $10/liter. A logistical advantage is that it can be acquired without going through a pharma company.

 

[dhb]

10$ a liter is cheap maybe it's the vaporizer that's expensive

 

[pgg]

10$ a liter is cheap maybe it's the vaporizer that's expensive

The gas is recyclable too. It's not like it's being thrown out the back of an ion engine into space at 50,000 m/s and lost forever.