Etomidate or Ketamine for RSI?

Thanks to one of our followers for the next question:

I am have been hearing many of my colleagues concerned about the potential harm created by adrenal suppression secondary to Etomidate use, especially in septic patients. A recent meta-analysis [Chan, C. et al Etomidate is associated with mortality and adrenal insufficiency in sepsis: A meta-analysis. Critical Care Medicine 2012 Nov;40(11):2945-53] found an association between Etomidate and increased mortality. I have two questions to ask:
1. Should I stop using Etomidate during RSI and switch to Ketamine? 
2. Is there literature to support the use of Ketamine during RSI  in patients with suspected increased intra-cranial pressure or intra-occular pressure?

So, what do you all think?

Haney Mallemat3 Comments