Sometimes, when I read a study, I think to myself – great study! If only they had sufficient enrollment to have power and validity! When I read this study, I thought, Heavens to Betsy – I am so glad they only subjected 12 patients to etomidate/fentanyl for sedation.
This is comparing ketamine/midazolam to etomidate/fentanyl for procedural sedation and the authors hoped that, perhaps, the shorter duration of action of etomidate would make it a viable alternative. But, it isn’t. Objective measures of procedural distress favored ketamine, parents favored ketamine, and the practitioners favored ketamine. Sedation time and recovery time favored etomidate – but at what cost? 18% of the ketamine group had an adverse event (vomiting, emergency reaction), while 50% of the etomidate group did (hypoxemia, etc.)
Propofol/fentanyl may be considered, but not etomidate/fentanyl.
“Ketamine/midazolam versus etomidate/fentanyl procedural sedation for pediatric orthopedic reductions.”
http://www.ncbi.nlm.nih.gov/pubmed/20502386