Browse the corpus

Etomidate is an ultrashort-acting, non-barbiturate hypnotic intravenous anesthetic agent. It is administered only by intravenous route. Etomidate has a favorable hemodynamic profile on induction, with minimal blood pressure depression, making it ideal for shock trauma, hypovolemic patients, or patients with significant cardiovascular disease. Etomidate has been approved for use during induction of general anesthesia, rapid sequence intubation, and other indications where short-term anesthesia is warranted. In addition, etomidate is indicated for procedural sedation, maintenance of anesthesia, and short operative procedures such as reducing dislocated joints, tracheal intubation, cardioversion, dilation, curettage, or cervical conization. This activity outlines the indications, mechanism of action, methods of administration, significant adverse effects, contraindications, toxicity, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) of etomidate so that providers can use it appropriately. Objectives: Identify the mechanism of etomidate that gives it its anesthetic properties. Review the indication for using etomidate, both on and off label. Describe the appropriate monitoring parameters for etomidate. Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients when using etomidate as an anesthesia agent. Access free multiple choice questions on this topic.

According to manufacturer labeling, overdose can occur from too rapid and repeated injections. In addition, the administration of rapid injections is followed by a fall in blood pressure. There is no antidote for etomidate. In a suspected case of overdosage, etomidate should be discontinued, a patent airway established (intubate, if necessary) or maintained, and oxygen administered with assisted ventilation.

Since etomidate is intended to induce general anesthesia, any clinician who administers etomidate must be trained in administering general anesthesia and managing complications encountered. In addition, emergency equipment must be readily available and in good working order. A trained, certified registered nurse anesthetist (CRNA) helps comprehensive perioperative care. Finally, hospital pharmacists should ensure proper dosing as the duration of action is closely related to the dose. In the case of overdose, critical care physician supervision is necessary. This interprofessional approach to etomidate use is crucial for optimal patient outcomes with the fewest adverse events. All clinicians (MDs, DOs, NPs, and PAs), nurses, pharmacists, and other staff involved must alert the rest of the interprofessional team to any changes in patient status, as well as document them in the patient's health record so all team members have access to the same information base. [Level 5] Clinicians should use the revised Cardiac Risk Index for Pre-Operative Riskto estimate the risk of cardiac complications after noncardiac surgery.[24] The decision to use etomidate as an induction agent is ultimately up to the clinician based on the physiologic state of their patient. Large, prospective controlled trials are still needed to determine the final role of etomidate, especially in critically ill patients. In the specific case of increasing the seizure duration potential, etomidate is superior to propofol and thiopental.[7] [Level 3]