Understanding Anesthesiology - The Global Regional Anesthesia ...

ETOMIDATE
Class
Short-acting hypnotic; anesthetic induction agent. Useful
in hemodynamically-compromised patients.
Mechanism of action
Potentiates the inhibitory GABA neurotransmitter resulting
in depression of the reticular activating system.
Dose
Induction: 0.2-0.6 mg/kg IV
Onset
Within one arm-brain circulation time (approximately
20 seconds).
Duration
Approximately 5-10 minutes after single induction dose.
Elimination
Rapid redistribution from central nervous system
(CNS) to lean body tissue accounts for brief duration of
action. Ultimately metabolized by hepatic and plasma
esterases to inactive products.
CVS
Etomidate is notable for the lack of significant cardiovascular
depression that it causes. Therefore it is commonly
chosen to facilitate intubation in the trauma patient,
patients with hypovolemic shock or other unstable
patients.
Respiratory
Etomidate causes a brief period of apnea.
GI
Nausea and vomiting
Misc.
Etomidate suppresses corticosteroid synthesis in the adrenal
cortex and can lead to primary adrenal suppression.
For this reason, its use in patients with sepsis is controversial.
Etomidate can result in trismus if administered
too quickly.
Effects
CNS
CNS depressant, potentiating the depressant effects of
opioids, sedatives and volatile anesthetics. Decreases
cerebral metabolic rate and intracranial pressure. The
cerebroprotective effects of etomidate make it useful in
the management of the head-injured patient. Can cause
seizure-like activity.
128