Etomidate Flashcards
What is the brand/trade name for etomidate?
What is the pharmacologic category/class of etomidate?
- General Anesthetic - Hypnotic
- Imidazole
Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 5. Etomidate: Part 1
What is the mechanism of action of etomidate?
Direct GABAA receptor agonist and potentiates actions of endogenous GABA → ⇑ Cl- conductance → neuronal hyperpolarization
Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 1. Propofol: Part 1
Nagelhout (7th ed.), p. 107
What is the adult dosing of etomidate for induction?
- 0.2-0.3 mg/kg IV, administered over 30-60 seconds
While this is the typical dose, the dosage range is 0.2-0.6 mg/kg
What is the onset of action for etomidate?
- 30-60 seconds
Be patient… it’s not as immediate as propofol
Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 5. Etomidate: Part 1
What is the duration of action for etomidate?
- 3-15 minutes — awakening is related to redistribution from brain
Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 5. Etomidate: Part 1
Dosing of etomidate for pediatric patients is similar to adults, but limited data is available for those under the age of ________
- 0.2-0.3 mg/kg IV, administered over 30-60 seconds
- 10 years - even less data is available for infants
Range of 0.2-0.6 mg/kg is also applicable to patients >10 years old
What organ(s) are responsible for etomidate’s clearance (metabolism/elimination)?
- Metabolism: Liver (P450) + plasma esterases
- Elimination: Kidneys
Half-life: ~75 minutes
Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 5. Etomidate: Part 1
Cardiovascular effects of etomidate include:
- Minimal change in HR, SV, or CO
- Small reduction in SVR/BP, but is usually insignificant unless patients have valvular disease
These are considered as advantages over propofol - cardiostable induction
Does NOT block SNS response to laryngoscopy
Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 5. Etomidate: Part 1
Nagelhout (7th ed.), pp. 107-108
What are the respiratory effects of etomidate?
- Mild dose dependent depression of ventilation - less than propofol or barbiturates (shifting of the CO2 response curve)
- Apnea following initial administration/induction
Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 5. Etomidate: Part 1
Nagelhout (7th ed.), p. 108
What effect does etomidate have on the CNS (e.g. CMRO2, cerebral blood flow, ICP)
- ↓ CMRO2, ↓ CBF (maintains coupling)
- ↓ ICP
- Myoclonus likely
Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 5. Etomidate: Part 1
Nagelhout (7th ed.), p. 107
Etomidate may cause pain or burning on injection - how can this be eliminated or minimized?
- Use of a larger and more proximal vein
- Giving an opioid or lidocaine prior to administration
Nagelhout (7th ed.), p. 108
What is the concentration (mg/mL) of etomidate vials?
Which adverse effect is more common with etomidate than with any other induction agent?
- PONV
Incidence may be as high as 30-40%
Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 6. Etomidate: Part 2
Nagelhout (7th ed.), p. 108
Name 2 significant contraindications to etomidate
-
adrenal suppression
(cortisol production decreases when certain enzymes are inhibited by etomidate) -
acute porphyrias
(RARE metabolic condition resulting in deficiency of enzymes needed to convert heme precursors to heme - worsened by etomidate)
Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 6. Etomidate: Part 2
Nagelhout (7th ed.), p. 108
