Etomidate: Difference between revisions

Latest revision as of 01:39, 13 June 2024

See critical care quick reference for drug doses by weight.

General

Type: Sedative
Dosage Forms: IV
Common Trade Names: Amidate, Tomvi

Adult Dosing

RSI

0.3mg/kg bolus IV
Average: 20mg
- Consider half-dose (0.15mg/kg) for obtunded patients

Procedural Sedation

0.1mg/kg one time dosing
Max: 10mg
Minimal respiratory depression but decrease blood pressure and heart rate (alpha2 agonism)

Pediatric Dosing

See critical care quick reference for drug doses by weight.

Children < 10 years
- 0.2-0.3 mg/kg IV
Children > 10 years
- 0.3 mg/kg IV

Special Populations

Pregnancy Rating: C
Lactation: etomidate is present in breast milk
Renal Dosing
- Adult
  - Not defined however higher risk of toxicity with renal impairment
- Pediatric
  - Not defined however higher risk of toxicity with renal impairment
Hepatic Dosing
- Adult
  - Not defined
- Pediatric
  - Not defined

Contraindications

Allergy to class/drug

Adverse Reactions

Myoclonus
Nausea/Vomiting
Pain at injection site
apnea

Controversy

May suppress adrenal function in critically ill patient
- "The available evidence suggests that etomidate suppresses adrenal function transiently without

demonstrating a significant effect on mortality. However, no studies to date have been powered to detect a difference in hospital, ventilator, or ICU length of stay or in mortality."^[1]

Meta-analysis in 2023 showed increased mortality in critically ill patients

Pharmacology

Half-life: 75 minutes
Metabolism: Liver
Excretion: Urine
Mechanism of Action: GABA agonist

References

↑ *Hohl CM, Kelly-Smith CH,Yeung TC, Sweet DD, Doyle-Waters MM, Schulzer M. The effect of a bolus dose of Etomidate on cortisol levels, mortality, and health services utilization: a systematic review. Ann Emerg Med. 2010;56(2):105-113.

Etomidate: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.

Authors:

[1] *Hohl CM, Kelly-Smith CH,Yeung TC, Sweet DD, Doyle-Waters MM, Schulzer M. The effect of a bolus dose of Etomidate on cortisol levels, mortality, and health services utilization: a systematic review. Ann Emerg Med. 2010;56(2):105-113.

[1]

@@ Line 1: / Line 1: @@
-==[[RSI]]==
+''See [[critical care quick reference]] for drug doses by weight.''
-.3 mg/kg bolus IV {Adult standard = 20mg)
+==General==
+*Type: [[Sedation|Sedative]]
+*Dosage Forms: IV
+*Common Trade Names: Amidate, Tomvi
-==[[Procedural Sedation]]==
+==Adult Dosing==
-.15 mg/kg bolus IV (Adult standard = 10mg)
+===[[RSI]]===
+*0.3mg/kg bolus IV
+*Average: 20mg
+**Consider half-dose (0.15mg/kg) for obtunded patients
-==Controversy==
+===[[Procedural Sedation]]===
-"The available evidence suggests that etomidate suppresses adrenal function transiently without
+{{Procedure sedation etomidate}}
-demonstrating a significant effect on mortality. However, no studies to date have been powered to detect a difference in hospital, ventilator, or ICU length of stay or in mortality."
-==Source==
+==Pediatric Dosing==
+''See [[critical care quick reference]] for drug doses by weight.''
-[[Category:Drugs]]
+*Children < 10 years
+**0.2-0.3 mg/kg IV
+*Children > 10 years
+**0.3 mg/kg IV
+==Special Populations==
+*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
+*Lactation: etomidate is present in breast milk
+*Renal Dosing
+**Adult
+*** Not defined however higher risk of toxicity with renal impairment
+**Pediatric
+*** Not defined however higher risk of toxicity with renal impairment
+*Hepatic Dosing
+**Adult
+*** Not defined
+**Pediatric
+*** Not defined
+==Contraindications==
+*Allergy to class/drug
+==Adverse Reactions==
+*Myoclonus
+*Nausea/Vomiting
+*Pain at injection site
+* apnea
+===Controversy===
+*May suppress adrenal function in critically ill patient
+**"The available evidence suggests that etomidate suppresses adrenal function transiently without
+demonstrating a significant effect on mortality. However, no studies to date have been powered to detect a difference in hospital, ventilator, or ICU length of stay or in mortality."<ref>*Hohl CM, Kelly-Smith CH,Yeung TC, Sweet DD, Doyle-Waters MM, Schulzer M.  The effect of a bolus dose of Etomidate on cortisol levels, mortality, and health services utilization: a systematic review.  Ann Emerg Med. 2010;56(2):105-113.</ref>
+*Meta-analysis in 2023 showed increased mortality in critically ill patients
+==Pharmacology==
+*Half-life: 75 minutes
+*Metabolism: Liver
+*Excretion: Urine
+*Mechanism of Action: GABA agonist
+==See Also==
+==References==
+<references/>
+[[Category:Pharmacology]]
+[[Category:Critical Care]]
+Etomidate: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.