If you're not seeing hypotension from etomidate inductions, you're either not looking, or you're decreasing the dose. My two other colleagues on my old hospital's CT team insisted on etomidate for all cardiac inductions, pushed 20mg on everyone, and pressure dropped every time. I saw the same in residency from attendings who were similarly dogmatic in insisting that all "sick" patients be induced with etomidate, then slamming in the full 0.2-0.3mg/kg. The hypotension didn't look as severe as with 2mg/kg propofol, but I don't push that much at once in anybody at once, anyway. When I first got to my old hospital, and didn't want to buck the system, I used etomidate, but decreased the dose. Often, 6-10mg on top of the little fent and midaz from preinduction CVC placement (our other institutional peculiarity) was sufficient, and very stable. Ultimately, I switched to ketamine/propofol (around 0.5mg/kg each), and see similar hemodynamics, but markedly reduced opiate use from the ketamine up front. In the past, I avoided etomidate because of fear of adrenal suppression, because I saw a whole ONE case of it, but now I don't use etomidate simply because I found an alternative that I like better, and fail to see what etomidate adds to my induction and anesthetic plan.
. Quick, dirty and easy.
