NATIONAL
CALIFORNIA
VENTURA
policies
mechanism
Ultra-short-acting nonbarbiturate general anesthetic (benzylimidazole) used for rapid induction of anesthesia with minimal cardiovascular effects.
indications
Rapid sequence intubation
contraindications
Hypersensitivity to etomidate or any component of the formulation
dosing

Adult

Note: Provides no analgesic effects.

IV: Initial: 0.3 mg/kg; consider 0.2 mg/kg in hemodynamically unstable patients

Pediatric

IV, Intraosseous: 0.2 to 0.4 mg/kg/dose as a single dose; maximum dose: 20 mg/dose

Note: Not recommended for patients in septic shock due to an association between transient adrenocortical suppression and increased mortality rate.

administration
IV: Administer IV push over 30 to 60 seconds. Solution is highly irritating; avoid administration into small vessels; in some cases, preadministration of lidocaine may be considered.
onset
30 to 60 seconds
peak
1 minute
duration
Dose dependent: 2 to 3 minutes (0.15 mg/kg dose); 3 to 5 minutes (0.3 mg/kg dose); rapid recovery is due to rapid redistribution
dosage form
2 mg/mL (10 mL, 20 mL)
pregnancy class
C
adverse reactions
  • Central nervous system:
    • Myoclonus (33%)
  • Endocrine & metabolic:
    • Adrenal suppression (>10%)
  • Gastrointestinal:
    • Nausea, vomiting (on emergence from anesthesia) (>10%)
    • Hiccups (<10%)
  • Local:
    • Pain at injection site (30% to 80%)
  • Neuromuscular & skeletal:
    • Transient skeletal movements (>10%)
  • Ophthalmic:
    • Nystagmus (>10%)
structure
Responsive image
warnings
  • Adrenal steroid production:
    • Etomidate inhibits 11-B-hydroxylase, an enzyme important in adrenal steroid production. A single induction dose blocks the normal stress-induced increase in adrenal cortisol production for 6 to 8 hours, up to 24 hours in elderly and debilitated patients.
  • Heart failure:
    • In a scientific statement from the American Heart Association, etomidate has been determined to be an agent that may exacerbate underlying myocardial dysfunction (magnitude: moderate).
  • Renal impairment:
    • Risk of toxicity is greater in patients with renal impairment; use with caution and monitor renal function.
  • Older adult:
    • May induce cardiac depression in elderly patients, especially those with hypertension; may require lower doses.