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Tue Dec 13 01:54:43 GMT 2005

A very interesting thread!

On our HEMS unit we tend to use the following 'recipes' for pre-hospital anaesthesia:

Adult:
Etomidate / Sux / Rocuronium for continued paralysis / Midazolam +/- Propofol for sedation
(Rocuronium alone if Sux contraindicated)
Child:
Ketamine / Sux or Roc / Midazolam for sedation

We do use Thiopentone (esp. for status) although the fact that it has to be prepared does put some off.
What does the list think about the continued use of Etomidate in Trauma management? I believe there has been some research that indicates that the adrenal suppression found with this agent has been found to occur following single dose administration. I am unclear whether this was a clinically significant phenomenon although obviously it is a concern in the poly-trauma patient. Incidently on our ICU we now check serum cortisol levels in all ICU admissions...together with adrenal response...and administer steroids as required. So this practise may obviate some of the concern. 
Any thoughts?

Dr Rob Thornhill MBChB DipIMC(RCS.Ed)
SpR Anaesthetics / ITU
HEMS Warwickshire & N'hants
rjthorn at btinternet.com

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