Anaes Cases · Intravenous induction agents
Induction of anaesthesia in the shocked patient
The induction-in-shock long case — the agent choice (ketamine or etomidate, never propofol/thiopental for their hypotension), the reduced dose, the cardiovascular-sparing reasoning, and the etomidate-adrenal caveat weighed against ketamine.
On this page
Study tools
Target exams
ANZCAFRCAABAEDAIC
Prompt
A 60-year-old man in septic shock (lactate 4, noradrenaline running, MAP 60) needs an emergency laparotomy for a perforated bowel. Discuss the choice of induction agent and dose.
Presentation
A 60-year-old man is in established septic shock from a perforated bowel: he is cool, confused, tachycardic at 120, the blood pressure is 95/50 on a rising noradrenaline infusion, the lactate is 4, and he needs an emergency laparotomy. The question is how to induce anaesthesia without precipitating a cardiovascular collapse.
References1ShowHide
- [1]Albert SG, Ariyan S, Rather A. The effect of etomidate on adrenal function in critical illness: a systematic review. Intensive Care Medicine, 2011.PMID 21373823