Results of a feasibility trial to achieve total immobilization of patients in a neurosurgical intensive care unit with etomidate.

In the intensive care unit of Leiden University Neurosurgical Department 52 critically ill patients were given continuous infusions of etomidate to achieve 'total immobilization'. This can be defined as a state whereby there is complete elimination of all psychic, sensory and motor unrest. Etomidate administration varied from 2 hours to 25 days and dosages began at 20 micrograms/kg/minute and were increased to 110 micrograms/kg/minute according to need and indications for varying periods of time. Attempts were made to control unrest, convulsive seizure activity and raised intracranial pressure. Acceptance of artificial ventilation was achieved in most cases without muscle relaxants or morphinomimetic supplementation. Despite the long durations of administration and high doses no toxic or other detrimental side-effects were noted. Etomidate appears to show the potential of being a very valuable addition to the neurosurgical intensive care armamentarium.