Indications
- Rapid Sequence Intubation (RSI)
Pharmacology
- General Anesthetic
- Inhibition of 11-β-Hydroxylase Enzyme
Administration
- IV (general anesthesia induction): 0.3 mg/kg over 30-60 sec
Dose Adjustment
- Hepatic: none (use with caution in liver disease)
- Renal: none
Adverse Effects
Cardiovascular Adverse Effects
Arrhythmias
- Epidemiology: occurs in <1% of cases
Hypertension (see Hypertension, [[Hypertension]])
- Epidemiology: occurs in <1% of cases
Hypotension (see Hypotension, [[Hypotension]])
- Epidemiology: occurs in <1% of cases
Sinus Bradycardia (see Sinus Bradycardia, [[Sinus Bradycardia]])
- Epidemiology: occurs in <1% of cases
Sinus Tachycardia (see Sinus Tachycardia, [[Sinus Tachycardia]])
- Epidemiology: occurs in <1% of cases
Endocrinologic Adverse Effects
Drug-Induced Primary Adrenal Insufficiency (see Adrenal Insufficiency, [[Adrenal Insufficiency]])
- Pharmacology: adrenal dysfunction occurs immediately and persists for as long as 48 hrs
- Clinical Efficacy
- Systematic Review (Int Care Med, 2011) [MEDLINE]
- Etomidate Increases the Risk of Adrenal Insufficiency and Mortality Rate in Critically Ill Patients
- Meta-Analysis of Etomidate (Crit Care Med, 2012) [MEDLINE]
- Etomidate (Used for Rapid Sequence Intubation) is Associated with Increased Risk of Adrenal Insufficiency and Mortality in Patients with Sepsis
- Systematic Review/Meta-Analysis of Etomidate in Sepsis (Chest, 2015) [MEDLINE]
- Single-Dose Etomidate Does Not Increase Mortality in Sepsis: however, authors noted that the conclusion largely relied on data from observational studies and that randomized trials are further needed
Gastrointestinal Adverse Effects
Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]])
- Epidemiology: occurs on emergence from anesthesia in >10% of cases
Neurologic Adverse Effects
Myoclonus (see Myoclonus, [[Myoclonus]])
- Epidemiology: occurs in 33% of cases
Transient Skeletal Movements
Uncontrolled Eye Movements
Otolaryngologic Adverse Effects
Laryngospasm (see Laryngospasm, [[Laryngospasm]])
- Epidemiology: occurs in <1% of cases
Pulmonary Adverse Effects
Hiccups (see Hiccups, [[Hiccups]])
- Epidemiology: occurs in 1-10% of cases
Hyperventilation (see Hyperventilation, [[Hyperventilation]])
- Epidemiology: occurs in <1% of cases
Respiratory Depression/Apnea (see Acute Hypoventilation, [[Acute Hypoventilation]])
- Epidemiology: occurs in <1% of cases
Other Adverse Effects
- Local Pain at Injection Site: occurs in 30-80% of cases
References
- The effect of etomidate on adrenal function in critical illness: a systematic review. Intensive Care Med 2011; 37:901-910. DOI: 10.1007/s00134-011-2160-1 [MEDLINE]
- Etomidate is associated with mortality and adrenal insufficiency in sepsis: A meta-analysis. Crit Care Med 2012; 40:2945-2953 [MEDLINE]
- Single-dose etomidate does not increase mortality in patients with sepsis: a systematic review and meta-analysis of randomized controlled trials and observational studies. Chest. 2015 Feb;147(2):335-46. doi: 10.1378/chest.14-1012 [MEDLINE]