Etomidate: Difference between revisions
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''See [[critical care quick reference]] for drug doses by weight.'' | ''See [[critical care quick reference]] for drug doses by weight.'' | ||
==General== | ==General== | ||
*Type: | *Type: [[Sedation|Sedative]] | ||
*Dosage Forms: | *Dosage Forms: IV | ||
*Common Trade Names: | *Common Trade Names: Amidate, Tomvi | ||
==Adult Dosing== | ==Adult Dosing== | ||
===[[RSI]]=== | ===[[RSI]]=== | ||
*0. | *0.3mg/kg bolus IV | ||
* | *Average: 20mg | ||
**Consider half-dose (0.15mg/kg) for obtunded patients | |||
===[[Procedural Sedation]]=== | ===[[Procedural Sedation]]=== | ||
{{Procedure sedation etomidate}} | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
''See [[critical care quick reference]] for drug doses by weight.'' | ''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== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*Lactation: | *Lactation: etomidate is present in breast milk | ||
*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult | ||
*** Not defined however higher risk of toxicity with renal impairment | |||
**Pediatric | **Pediatric | ||
*** Not defined however higher risk of toxicity with renal impairment | |||
*Hepatic Dosing | *Hepatic Dosing | ||
**Adult | **Adult | ||
*** Not defined | |||
**Pediatric | **Pediatric | ||
*** Not defined | |||
==Contraindications== | ==Contraindications== | ||
| Line 41: | Line 43: | ||
*Nausea/Vomiting | *Nausea/Vomiting | ||
*Pain at injection site | *Pain at injection site | ||
* apnea | |||
===Controversy=== | ===Controversy=== | ||
"The available evidence suggests that etomidate suppresses adrenal function transiently without | *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> | 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== | ==Pharmacology== | ||
*Half-life: | *Half-life: 75 minutes | ||
*Metabolism: | *Metabolism: Liver | ||
*Excretion: | *Excretion: Urine | ||
*Mechanism of Action: | *Mechanism of Action: GABA agonist | ||
==See Also== | ==See Also== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
[[Category:Critical Care]] | |||
Etomidate: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019. | |||
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
- Adult
- Hepatic Dosing
- Adult
- Not defined
- Pediatric
- Not defined
- Adult
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
See Also
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.