Overview
Etomidate is a short-acting intravenous anesthetic agent used for induction of general anesthesia. It provides rapid onset of anesthesia with minimal cardiovascular depression, making it particularly useful in patients with compromised cardiac function or hemodynamic instability.
Mechanism of Action
Etomidate acts as a positive allosteric modulator of the GABA-A receptor, enhancing GABA-mediated chloride currents, leading to neuronal hyperpolarization and CNS depression. It has minimal effects on cardiovascular and respiratory systems compared to other induction agents.
Indications
- Induction of general anesthesia
- Rapid sequence intubation
- Procedural sedation in selected cases
Dosage
Adults: 0.2-0.6 mg/kg IV over 30-60 seconds for induction. Elderly/debilitated: Reduce dose. Pediatric: 0.2-0.3 mg/kg IV. Administer immediately before use as solution is unstable.
Black Box Warning
Not for use by continuous infusion. Single doses or intermittent bolus injections of etomidate may be associated with mortality in patients with sepsis or other conditions where adrenal function may be compromised.
Contraindications
- Hypersensitivity to etomidate or components
- Porphyria
- Known adrenal insufficiency
Side Effects
- Pain at injection site
- Myoclonus
- Nausea/vomiting
- Transient apnea
- Hiccups
- Adrenal suppression
- Hypertension/hypotension
- Arrhythmias
Interactions
- Enhanced CNS depression with other CNS depressants
- Increased risk of adrenal suppression with corticosteroids
- Possible interaction with drugs affecting CYP450 enzymes