Midazolam is more likely to cause hypotension than etomidate in emergency department rapid sequence intubation

• Published in: Emergency medicine journal : EMJ 2004-11, Vol.21 (6), p.700-702
• Main Authors: Choi, Y F, Wong, T W, Lau, C C
• Format: Article
• Language: English
• Subjects: Age; Age Factors; Aged; Anesthetics, Intravenous - adverse effects; Blood pressure; Blood Pressure - physiology; Emergency Treatment; etomidate; Etomidate - adverse effects; Female; Humans; hypotension; Hypotension - chemically induced; Intubation; Intubation, Intratracheal - methods; Male; midazolam; Midazolam - adverse effects; Middle Aged; Mortality; Neuromuscular Agents - adverse effects; Original; Patients; Premedication - adverse effects; Premedication - methods; Prospective Studies; rapid sequence intubation; RSI; SBP; Studies; systolic blood pressure
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emj.2002.004143

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.