Etomidate
Amidate
Imidazole IV induction agent
GABA-A potentiation. Highly hemodynamically stable due to minimal SVR/contractility effects.
Indications
- •GA induction in hemodynamically unstable patients
- •RSI in shock
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Induction | 0.2–0.3 mg/kg IV | 0.2–0.3 mg/kg IV |
Pharmacokinetics
Onset 30–60 sec. Duration 5–10 min. Hepatic ester hydrolysis.
Hemodynamic effects
Minimal effect — drug of choice for cardiac compromise, hypovolemia, acute trauma.
Respiratory effects
Less apnea than propofol. CO₂ response preserved at induction doses.
Side effects
- !Adrenocortical suppression (11β-hydroxylase) for 6–24 h after a single dose — relevant in septic patients
- !Myoclonus during induction (50%) — pretreat with opioid or low-dose midaz
- !Injection pain in propylene glycol formulation
- !PONV ~30%
Contraindications
- ×Septic shock with adrenal insufficiency (relative — controversial)
Clinical pearls
- ★Single-dose adrenal suppression mortality signal in sepsis is small but real; consider hydrocortisone supplement.
- ★No analgesia — co-administer opioid.
Education only — confirm against current package inserts and institutional protocols. Doses assume normal organ function unless otherwise noted.