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American Journal of Critical Care. 2010;19: 48-54 doi:10.4037/ajcc2010562
Copyright © 2010 by the American Association of Critical-Care Nurses.
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A Comparison of Methohexital Versus Etomidate for Endotracheal Intubation of Critically Ill Patients

By Enrique Diaz-Guzman, MD, Eduardo Mireles-Cabodevila, MD, Gustavo A. Heresi, MD, Seth R. Bauer, PharmD and Alejandro C. Arroliga, MD. Enrique Diaz-Guzman is an assistant professor at the University of Kentucky and chief of the pulmonary section at the Veterans Affairs Hospital of Lexington, Kentucky. Gustavo A. Heresi is an associate staff in the Respiratory Institute and Seth R. Bauer is a clinical specialist from the Department of Pharmacy at the Cleveland Clinic, Ohio. Eduardo Mireles-Cabodevila is an assistant professor at the University of Arkansas for Medical Sciences in Little Rock. Alejandro C. Arroliga is a professor of medicine at Texas A&M Health Science Center College of Medicine and director of the Division of Pulmonary and Critical Care Medicine at Scott & White Healthcare in Temple, Texas.

Corresponding author: Enrique Diaz-Guzman, MD, Department of Pulmonary, Sleep, and Critical Care, University of Kentucky, 740 S Limestone St, L543 Kentucky Clinic, Lexington, KY 40536 (e-mail: enriquedgz{at}uky.edu).

Background Methohexital has been used for procedural sedation in the emergency department, but its use for endotracheal intubation in intensive care units has not been studied.

Objective To compare methohexital with etomidate with respect to their effectiveness and safety of use for endotracheal intubation in the intensive care unit.

Methods Retrospective, observational, single-center cohort study of consecutive patients admitted between December 2006 and August 2007 to a medical intensive care unit in a tertiary-care hospital.

Results Twenty-three patients who received methohexital and 23 who received etomidate for endotracheal intubation were included. The 2 groups differed in age (mean [SD], 55 [13] vs 64 [13] years, P = .03) but not in baseline demographics or illness severity scores. Mean (SD) doses given were 1 (0.2) mg/kg for methohexital and 0.2 (0.1) mg/kg for etomidate. Use of midazolam, fentanyl, and succinylcholine was similar between the groups. Rates of successful intubation after 1 attempt (78% vs 83%), time to successful intubation (mean, 5.9 vs 4 minutes), and number of intubation attempts (mean, 1.5 vs 1.2) also were similar. Change in hemodynamics (delta systolic blood pressure), vasopressor requirements, and amount of fluid resuscitation (normal saline) did not differ significantly between the groups.

Conclusions Rates of successful intubation are similar with etomidate and methohexital. Methohexital provides adequate sedation and could be an alternative to etomidate, although both agents were often associated with development of hypotension. Prospective studies are needed to establish the safety of methohexital use in intensive care patients.






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Copyright © 2010 by the American Association of Critical-Care Nurses.