Etomidate 20mg/10ml solution for injection ampoules

BackgroundEtomidate, ketamine, and propofol are all used as induction agents for emergency tracheal intubation in critically ill adults but it remains uncertain which agent should be preferable.MethodsWe searched MEDLINE and Embase (inception to December 2025) for randomized controlled trials comparing etomidate, ketamine, propofol, or ketamine-propofol combination (ketofol) for emergency or rapid sequence intubation in critically ill adults. We performed random-effects network meta-analysis using the frequentist framework. The primary outcome was short-term mortality (28-30 day, or ICU/in-hospital mortality when unavailable). Secondary outcomes included cardiovascular collapse, post-induction hypotension, vasopressor use, first-pass intubation success, and peri-intubation cardiac arrest. Certainty of evidence was assessed using the CINeMA framework.ResultsNine trials (4,672 patients, four treatments) were included. Ketamine and etomidate probably result in similar mortality (OR 0.96, 95% CI 0.80-1.16; [Formula: see text] = 30%; moderate certainty). Evidence for other mortality comparisons was very uncertain: ketamine vs propofol (OR 1.53, 0.80-2.93; 1 trial; low certainty) and etomidate vs propofol (OR 0.63, 0.32-1.24; indirect only; very low certainty). Compared with etomidate, ketamine probably increases cardiovascular collapse (OR 1.44, 1.20-1.71; moderate certainty) and may increase post-induction hypotension (OR 1.34, 1.07-1.68; low certainty) and peri-intubation vasopressor use (OR 1.45, 1.21-1.74; low certainty). There was probably little or no difference in first-pass intubation success or cardiac arrest.ConclusionsEtomidate and ketamine probably result in similar mortality, but confidence intervals are compatible with clinically important differences in either direction-ketamine probably causes more peri-intubation hemodynamic instability. Beyond one trial, no randomized evidence exists for propofol in emergency intubation of critically ill adults.

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ObjectiveEtomidate and ketamine are hemodynamically stable induction agents for rapid sequence intubation (RSI) of critically ill patients. Despite their relative stability in terms of hemodynamics, how the choice of agent affects mortality and the success of the procedure is debatable and has not yet been explored via systematic review and meta-analysis. The objective of this systematic review is to compare the efficacy of ketamine and etomidate for RSI in terms of mortality, hemodynamic parameters, and success rate.MethodsA comprehensive search of PubMed, Embase, and the Web of Science was conducted from the starting date of each database until April 2024. Randomized controlled trials comparing the safety and efficacy of ketamine and etomidate as induction drugs for critically ill patients undergoing RSI were included. The primary outcome was the risk of 28-day mortality, and the secondary outcomes included the success rate and postinduction hypotension. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis.ResultsFour studies with 1,663 patients were meta-analyzed, and no statistically significant difference between the two drugs was found for 28-day mortality (RR, 0.95; 95% CI, 0.72-1.25; heterogeneity I2=39%; level of certainty of evidence per GRADE, moderate), first-pass success rate (RR, 1.00; 95% CI, 0.97-1.03), or postinduction cardiac arrest (RR, 1.10; 95% CI, 0.62-1.96). Postinduction hypotension was higher in the ketamine group (RR, 1.30; 95% CI, 1.03-1.64), but the result was not statistically significant.ConclusionMortality outcomes did not differ when ketamine or etomidate was used for RSI in critically ill patients. Ketamine, however, was associated with a non-significantly higher risk of postinduction hypotension.

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Objective Explore the clinical efficacy and safety of ciprofol-etomidate (C-E) versus propofol-etomidate (P-E) for gastrointestinal endoscopy sedation, and generate hypotheses for subsequent prospective pre-registered trials. Methods A prospective, double-blind, randomized, positive-controlled exploratory trial enrolled 240 adults (120 per group). Exploratory outcomes included hemodynamics, adverse events, and Chalder Fatigue Questionnaire (CFQ) scores. Intention-to-treat (ITT) analysis was primary, with per-protocol analysis (PPA, n  = 223) as sensitivity validation. Results C-E group showed significantly lower CFQ Bimodal scores ≥4, postoperative dizziness incidence, and blood pressure fluctuations (>20% baseline; all p  < 0.05). One P-E patient needed respiratory support for SpO₂ = 85%. Other outcomes (e.g., induction time, total dose) were comparable. ITT and PPA results were consistent. Conclusion This retrospective registered exploratory study tentatively suggests C-E may offer potential advantages in hemodynamic stability, respiratory safety, and reduced post-procedural fatigue/dizziness for low-risk (ASA I ~ II) patients. Findings are hypothesis-generating and require validation via prospective pre-registered trials. Systematic review registration https://www.chictr.org.cn/indexEN.html , identifier ChiCTR2500107221.

Abstract licence: CC BY 4.0