Etomidate (Amidate)

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

  • xxx

Uncontrolled Eye Movements

  • xxxx

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]