RESEARCH Comparison of clinical out t

Full list of author information is available at the end of the articleIntroduction Etomidate is considered an almost ideal induction agent be-cause of the rapid onset and the predictable short duration of action in combination with minimal implications for the cardiovascular and pulmonary system [1]. These effects and benefits are even more important in high-risk cardiac sur-gery patients. However, soon after licensing of etomidate for long-term sedation and anesthesia in 1972, an increased mortality in intensive care patients resulted in recommen-dations to stop long-term use [2-4]. Even a single dose of etomidate inhibits transiently adrenal mitochondrial 11-β-hydroxylase activity with consecutive adrenal suppression [5,6]. Ever since, intensive care, emergency, and anesthesia communities have been discussing the use of even a single dose of etomidate controversially. Various studies and meta-analyses found either an increased [7-10] or an equal [11-17] risk of mortality and risk variables after administra-tion of etomidate in critically ill patients with sepsis. In trauma patients, an increased susceptibility to pneumoni