Etomidate as anesthetic agent in asthmatic child with food allergy

Children with bronchial asthma and respiratory infections have significant peri-operative implications for the anaesthesiologists. With improvements in medical knowledge and anaesthesia techniques, morbidity and mortality associated with an asthmatic child undergoing surgery have come down. Etomidate is an intravenous anesthetic agent whose clinical effects are the result of potentiation of the gamma-amino butyric acid inhibitory neurotransmitter system with the alteration of transmembrane chloride conductance. Physicians commonly use etomidate for adult rapid-sequence intubation, but the manufacturer does not recommend its use for children under 10 years of age due to a lack of data. Ketamine has been suggested as an alternative agent given its limited effects on hemodynamic function related to the release of endogenous catecholamines. A child aged 11 years and weighing 40 kg, with egg allergy and a more general allergic predisposition, with a history of asthma treated with inhalants and a recent respiratory infection with antibiotics, came with a diagnosis of acute abdomen. Etomidate was used as an anesthetic agent in combination with ketamine, using rocuronium and sevoflurane. Corticosteroids and aminophylline were given to prevent bronchospasm. Ketamine and etomidate, both of which provide effective sedation with limited effects on hemodynamic function, have become increasingly popular as induction agents.