ABSTRACT
Introducción: La secuencia de intubación rápida es una técnica de protección y rescate de la vía aérea que requiere el uso de sedantes para propiciar un adecuado escenario durante la intubación orotraqueal. Son utilizados diferentes sedantes inductores, siendo el etomidato el más común por sus cualidades farmacocinéticas y farmacodinámicas, donde resalta su estabilidad hemodinámica. Sin embargo, en comparación con otros sedantes esta superioridad es controvertida. Materiales y métodos: Se realizó un metaanálisis con un protocolo definido a priori y siguiendo las etapas de la guía PRISMA. Se calculó la diferencia de medias de la presión arterial sistólica antes y después de la administración del sedante, además de un metaanálisis de riesgos relativos de hipotensión. Resultados: Se incluyeron 10 estudios en los cuales la incidencia de hipotensión en el grupo de pacientes que recibió el etomidato osciló entre el 6,4% y el 75,2%, mientras que en los que recibieron otros sedantes osciló entre el 24,0% y el 65,9%. En los metaanálisis de diferencia de medias no se hallaron diferencias significativas de la presión arterial sistólica durante la preintubación 0,01mmHg (IC 95%: 0,90; 0,92), ni en la postintubación 0,98mmHg (IC 95%: 0,24; 2,20). Además, el metaanálisis de riesgos relativos indica que el riesgo de hipotensión es igual a un RR 1,19 (IC 95%: 0,92-1,54) entre quienes recibieron el etomidato y aquellos que recibieron los otros sedantes. Conclusiones: El riesgo de hipotensión posterior a la secuencia de intubación rápida con etomidato no presenta diferencias significativas comparado con otros sedantes. Sin embargo, hay heterogeneidad en los estudios incluidos.(AU)
Introduction: Rapid sequence intubation is an airway rescue and protection technique in which different sedatives are used to perform orotracheal intubation. Etomidate, due to its pharmacokinetic and pharmacodynamic qualities, particularly hemodynamic stability, is the most widely used sedative in this scenario. However, its superiority over other sedatives is controversial. Materials and methods: We performed a meta-analysis using a pre-designed protocol and PRISMA guidelines to evaluate the mean difference between systolic blood pressure before and after administration of the sedative. We also analyzed the relative risks of hypotension. Results: Ten studies were included. The incidence of hypotension in patients receiving etomidate ranged from 6.4% to 75.2%, and between 24.0% and 65.9% in patients receiving other sedatives. No significant differences were found in the mean difference in systolic blood pressure during pre-intubation 0.01mmHg (95% CI: 0.90; 0.92) or in post-intubation 0.98mmHg (95% CI: 0.24; 2.20). The relative risk analysis showed that the risk of hypotension is equal to an RR of 1.19 (95% CI: 0.92-1.54) between those who received etomidate and those who received the other sedatives. Conclusions: The risk of hypotension after rapid intubation sequence with etomidate does not differ significantly compared to other sedatives. However, the studies included in this review were heterogeneous.(AU)
Subject(s)
Humans , Hemodynamics , Etomidate , Intubation , Hypnotics and Sedatives , Hypotension , Anesthesiology , Arterial PressureABSTRACT
INTRODUCTION: Rapid sequence intubation is an airway rescue and protection technique in which different sedatives are used to perform orotracheal intubation. Etomidate, due to its pharmacokinetic and pharmacodynamic qualities, particularly hemodynamic stability, is the most widely used sedative in this scenario. However, its superiority over other sedatives is controversial. MATERIALS AND METHODS: We performed a meta-analysis using a pre-designed protocol and PRISMA guidelines to evaluate the mean difference between systolic blood pressure before and after administration of the sedative. We also analyzed the relative risks of hypotension. RESULTS: Ten studies were included. The incidence of hypotension in patients receiving etomidate ranged from 6.4% to 75.2%, and between 24.0% and 65.9% in patients receiving other sedatives. No significant differences were found in the mean difference in systolic blood pressure during pre-intubation 0.01 mm Hg (95% CI: -0.90; 0.92) or in post-intubation 0.98 mmHg (95% CI: -0.24; 2.20). The relative risk analysis showed that the risk of hypotension is equal to an RR of 1.19 (95% CI: 0.92-1.54) between those who received etomidate and those who received the other sedatives. CONCLUSIONS: The risk of hypotension after rapid intubation sequence with etomidate does not differ significantly compared to other sedatives. However, the studies included in this review were heterogeneous.
