etomidate

General

High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error.

Pronunciation:
e-toe-mi-date

Trade Name(s)

• Amidate

Ther. Class.

general anesthetics

Pharm. Class.

nonbarbiturates

Indications

• Induction of general anesthesia.
• Supplemental anesthesia with other agents (nitrous oxide) for short procedures.

Action

Hypnotic CNS depressant without analgesic activity.

Therapeutic Effect(s):

Induction/supplementation of general anesthesia.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Distributes rapidly from blood into CNS, followed by rapid clearance and tissue distribution.

Metabolism and Excretion: Mostly metabolized by the liver. 75% excreted in urine as inactive metabolite; 10–13% excreted in bile and feces.

Half-life: 1.25–5 hr.

TIME/ACTION PROFILE (hypnosis)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity
• Prolonged infusion not recommended (suppresses cortisol production)
• OB:  Pregnancy, labor, delivery (including cesarean section); may affect child's brain development when used during 3rd trimester.

Use Cautiously in:

• Patients undergoing severe stress (may require supplemental corticosteroids)
• Geri:  Geriatric patients
• Lactation:  Safety not established
• Pedi:   Children <10 yr (safety not established); Children <3 yr (may affect brain development).

Adverse Reactions/Side Effects

CV: arrhythmias, hypertension, hypotension

GI: postoperative nausea/vomiting

Local: transient injection site pain

MS: transient skeletal muscle movements

Resp: APNEA, hyperventilation, hypoventilation, LARYNGOSPASM

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• ↑ CNS depression with other CNS depressants including  antihistamines,  antidepressants,  sedative/hypnotics,  antipsychotics  and  opioids ; ↓ dosage of other CNS depressants if necessary.
•  Verapamil  may ↑ anesthetic effect, which may ↑ risk of respiratory depression and apnea.

Route/Dosage

IV (Adults and Children  >10 yr): 0.2–0.6 mg/kg (usual dose is 0.3 mg/kg) for induction. Smaller increments may be used during short procedures to supplement other agents.

Availability (generic available)

Solution for injection: 2 mg/mL

Assessment

• Assess respiratory status, pulse, and BP continuously throughout etomidate therapy. May cause brief periods of apnea. Maintain patent airway and adequate ventilation.
• Assess level of sedation and level of consciousness throughout and following administration.
• May cause pain at injection site lasting <1 min. Pain is less frequent when larger veins are used for injection.

If overdose occurs, monitor pulse, respiration, and BP continuously. Maintain patent airway and assist ventilation as needed.

Implementation

• High Alert: Etomidate should be used only by individuals experienced in endotracheal intubation. Equipment for airway management should be readily available.

• Dose is titrated to patient response.

  • Etomidate has no effect on the pain threshold. Adequate analgesia should  always  be used when etomidate is used as an adjunct to surgical procedures.
  • Opioid analgesics, such as fentanyl, may be administered immediately prior to etomidate to provide analgesia, minimize pain at injection site and involuntary muscle movements. Diazepam may also be used to reduce incidence and magnitude of involuntary muscle movements.

Patient/Family Teaching

• Inform patient of the purpose of medication.
• May cause drowsiness or dizziness. Advise patient to request assistance prior to ambulation and transfer and to avoid driving or other activities requiring alertness for 24 hr following administration.
• Advise patient to avoid alcohol or other CNS depressants without the advice of a heath care professional for 24 hr following administration.

Evaluation/Desired Outcomes

Induction and maintenance of anesthesia.