Home Drug Guide Etomidate

Drug Guide

Generic Name

Etomidate

Brand Names Amidate

Classification

Therapeutic: Anesthetic agent

Pharmacological: imidazole derivative, GABA_A receptor modulator

FDA Approved Indications

  • Induction of anesthesia during procedures

Mechanism of Action

Enhances the activity of GABA at the GABA_A receptor, leading to increased chloride ion influx and neuronal hyperpolarization, which produces sedative and hypnotic effects.

Dosage and Administration

Adult: 0.2-0.6 mg/kg IV administered over 30-60 seconds; dosage may vary based on patient condition and procedure

Pediatric: 0.2-0.4 mg/kg IV, titrated as needed

Geriatric: Lower doses are recommended due to increased sensitivity, typically starting at the lower end of dosing range

Renal Impairment: Use with caution; adjustment may be necessary based on clinical response

Hepatic Impairment: Use with caution; no specific adjustment recommended but monitor closely

Pharmacokinetics

Absorption: Rapid after IV administration

Distribution: Widely distributed; crosses the blood-brain barrier

Metabolism: Hepatic; primarily by ester hydrolysis to inactive metabolites

Excretion: Renal mainly as metabolites

Half Life: 2-4 minutes (initial); terminal half-life approximately 2-5 hours

Contraindications

  • Known hypersensitivity to etomidate or other imidazoles

Precautions

  • Use cautiously in patients with compromised adrenal function, history of seizure disorders, or cardiovascular instability; may suppress adrenal cortisol synthesis

Adverse Reactions - Common

  • Myoclonus (Occasional)
  • Nausea and vomiting (Less common)

Adverse Reactions - Serious

  • Adrenal suppression (Potentially significant with prolonged use or repeated doses)
  • Apnea (Rare but can occur, especially if dose administered too rapidly)
  • Hypotension (Less common, may be dose-dependent)

Drug-Drug Interactions

  • Caution when used with other CNS depressants, including opioids and benzodiazepines, due to additive sedative effects

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor vital signs, oxygen saturation, neurological status

Diagnoses:

  • Risk of respiratory depression
  • Risk for hypotension
  • Potential for adverse reactions like myoclonus or nausea

Implementation: Administer slowly as per protocol, have resuscitation equipment available, monitor for adverse effects

Evaluation: Assess patient for adequate anesthesia, stability of vital signs, and recovery progress

Patient/Family Teaching

  • Inform patient that they may experience temporary dizziness, nausea, or muscle twitching after administration
  • Assure them that the effects wear off quickly and normal activities can resume shortly afterward

Special Considerations

Black Box Warnings:

  • None currently

Genetic Factors: None notable

Lab Test Interference: None

Overdose Management

Signs/Symptoms: Deep sedation, respiratory depression, apnea, hypotension, myoclonus

Treatment: Supportive care; manage airway and breathing; administer intravenous fluids or vasopressors for hypotension; provide ventilatory support if needed; administration of lipid emulsion therapy is not indicated.

Storage and Handling

Storage: Store at room temperature, protected from light and moisture

Stability: Stable until expiration date when stored properly

This guide is for educational purposes only and is not intended for clinical use.