What sedative should be avoided in rapid sequence intubation (RSI) in septic patients?

Etomidate is considered the sedative to avoid in rapid sequence intubation (RSI) in septic patients primarily due to its effect on adrenal function. In patients who are septic, there is a risk of adrenal insufficiency, and etomidate can severely suppress cortisol production. This is critical because patients with sepsis often require adequate cortisol levels to manage their stress response and maintain hemodynamic stability.

While etomidate is known for its cardiovascular stability and rapid onset, the potential of causing significant adrenal suppression raises concerns in the context of septic patients who may already be in a precarious state. Instead, other sedatives like propofol and ketamine offer a more favorable profile for use in this population by minimizing the risk of adrenal suppression and supporting hemodynamic stability.

Overall, while etomidate may be safe in certain situations, its use in septic patients should be approached with caution due to these important endocrine considerations.