Retrospective Review of Propofol versus Etomidate during Rapid Sequence Intubation in the Emergency Department at a Tertiary Academic Center

Background: Etomidate is the standard induction agent used during rapid sequence intubation (RSI) in the emergency department (ED). Etomidate shortages require providers to utilize alternative agents. The purpose of this study is to compare the safety and procedural outcomes of propofol and etomidate for RSI in the ED. Methods: This was a retrospective chart review of adult patients in the ED who received propofol or etomidate for induction during RSI. The main endpoint was hypotension, defined as a systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg, within the first hour of intubation. Time to intubation, intensive care unit length of stay, hospital length of stay, and in-hospital mortality were also evaluated. Results: Two hundred and seventy five patient charts were reviewed. Of the 98 patients included, 43 patients received propofol and 55 patients received etomidate. Propofol was associated with an increased incidence of hypotension within the first hour of intubation (65.1% vs. 25.5%, p < 0.001). No difference was found in the time to intubation: ≤5 minutes (51.2% vs. 34.6%, p = 0.83). The mortality rate was 11.6% in the propofol group and 27.3% in the etomidate group (p = 0.004). There was no difference in hospital or intensive care unit length of stay between the propofol and etomidate groups (7.7 vs. 9.2 days, p = 0.23;4.2 vs. 6.3 days, p = 0.31). Conclusion: Propofol was a safe and procedurally effective induction agent for RSI. Compared to etomidate, it was associated with an increased rate of hypotension within the first hour of intubation, with no difference in the percent of patients that required an intervention.

From Hai Yao, Yang Yao to Xi Yao: Sinification of Material Medical from the West

In ancient China, Daoist philosophers developed the concepts of qi(energy), Wu Xing(five elements), and yin(feminine, dark, negative) and yang(masculine, bright, positive) opposite forces between 200 and 600 BCE. Based on these philosophies, Zhen Jiu(acupuncture), Ben Cao(materia medica), and the practice of Qi Gong(energy optimization movements) evolved as the three interrelated therapeutic regimens of Chinese medicine(Note 1). Since the time of Zhang Qian, who discovered China's western regions in the 1st century BCE, Hai Yao(the exotic elements of materia medica from the maritime Silk Road countries), had been transmitted from the ancient land and maritime routes of the Silk Road to China in the past two millennia(Note 2). Since the late 17th century, the English East India Company, later called the British East India Company, introduced Yang Yao(opium) to the Manchu Qing Empire to balance a growing trade deficit for tea export from China to the British Empire. After the First Opium War ended in 1842, enterprising expatriate chemists and druggists in the treaty ports imported Xi Yao(modern medicines from the Western world) for sale to the merchant navy and the local market. From the second half of the 19th century onwards, both Hai Yao and Xi Yao have become a fully integrated part of modern China's armamentarium for the Chinese medicine and Western hospitals and retail pharmacy sectors. This paper articulates the journey of adoption of exotic elements of materia medica from the ancient land and sea routes of the Silk Road, including the western regions and the rest of the world in the past two millennia. Opium traders, ship surgeons, medical and pharmaceutical missionaries, enterprising traders, and policymakers together transformed Ben Cao into Xi Yao during the late Manchu Qing dynasty and the early Nationalist Era.