Etomidate Flashcards
(36 cards)
Etomidate
Dose for Induction for General Anesthesia in Adults
IV: Initial:
0.3 mg/kg
Range: 0.2 to 0.6 mg/kg over 30 to 60 seconds for induction of anesthesia.
Etomidate
Dose for Procedural Sedation
IV: Initial:
0.1 to 0.2 mg/kg, followed by 0.05 mg/kg every 3 to 5 minutes as needed
Etomidate
Dose for Cushing Syndrome
IV: Initial:
0.04 to 0.05 mg/kg/hour (usually equates to ~2.5 to 3 mg/hour).
Titrate to serum cortisol of 18 to 29 mcg/dL (500 to 800 nmol/L) in a physiologically stressed patient or 5.5 to 11 mcg/dL (150 to 300 nmol/L) in a non-physiologically stressed patient.
For complete blockade, titrate infusion rate to achieve a cortisol level <5.5 mcg/dL (<150 nmol/L).
Hydrocortisone IV is required if complete blockade desired rather than partial blockade (‘block and replace’)
Etomidate
Are there renal impairment adjustments?
Dosing: Renal Impairment:
Adult
There are no dosage adjustments provided in the manufacturer’s labeling; use with caution, risk of toxicity is greater in patients with renal impairment.
Etomidate
Are there hepatic impairment dosing adjustments / considerations?
There are no dosage adjustments provided in the manufacturer’s labeling.
Hepatic function impairment:
Vd and elimination half-life increase 2-fold in patients with cirrhosis compared with healthy subjects.
Etomidate
Dose for Induction for General Anesthesia in Infants
IV: 0.2 to 0.3 mg/kg/dose as a single dose; dosing based on a prospective
Observational trial and two pharmacokinetic studies (Kay 1976; Lin 2012; Su 2015)
Etomidate
Dose for Induction for General Anesthesia in Children <10
IV:
0.2 to 0.3 mg/kg/dose as a single dose (Coté 2013; Du 2015; Kay 1976)
Etomidate
Dose for Induction for General Anesthesia in Children >10 and Adolescents
Usual dose: IV:
0.3 mg/kg/dose as a single dose; range: 0.2 to 0.6 mg/kg/dose
Etomidate
Procedural Sedation Dose for >6 mo, children, adolescents
Infants ≥6 months, Children, and Adolescents
IV: Usual initial dose: 0.2 mg/kg/dose prior to procedure
(reported range: 0.1 to 0.4 mg/kg/dose); repeat doses may be needed depending on patient response and duration of the procedure; repeat doses vary in the literature and
Range from 0.1 to 0.2 mg/kg/dose
Reported total dose ranged from 0.3 to 0.6 mg/kg/procedure
Does Etomidate have analgesic properties?
Etomidate does not have analgesic properties
Etomidate RSI dose
- Weight based?
- Max dose?
Infants, Children, Adolescents
Children, and Adolescents
IV, Intraosseous: 0.2 to 0.4 mg/kg/dose as a single dose
Maximum dose: 20 mg/dose
Can you administer Etomidate with Lidocaine?
Solution is highly irritating; avoid administration into small vessels; in some cases, preadministration of lidocaine may be considered.
What is the most common side effect for Central nervous system for Etomidate?
Central nervous system: Myoclonus (33%)
Myoclonus refers to a quick, involuntary muscle jerk.
What is the most common side effect for Endocrine for Etomidate?
Adrenal suppression
What is the most common side effect for GI for Etomidate?
Nausea, vomiting (on emergence from anesthesia)
10% get Hiccups
What is the most common side effect for MSK for Etomidate?
Musculoskeletal disease (transient skeletal movements)
What is the most common side effect for Ophthalmological for Etomidate?
Ophthalmic: Nystagmus
What enzyme does Etomidate inhibit?
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.
Are there concerns for single dose induction for adrenal suppression?
No increase in mortality has been identified with a single dose for induction of anesthesia (McPhee 2013).
What special population and pathology do you have to consider with Etomidate?
• Elderly: May induce cardiac depression in elderly patients, especially those with hypertension; may require lower doses.
Does Etomidate Cross the Placenta?
Etomidate crosses the placenta (Esener 1992; Gregory 1991).
Is Etomidate used for induction for Caesarian deliveries?
Use of etomidate for induction of anesthesia prior to cesarean delivery has been described (Downing 1979; Houlton 1978; Regaert 1984). However, other agents may be more commonly used
Is Etomidate Present in Breast Milk?
Etomidate is present in breast milk (Esener 1992).
Following use of etomidate as an induction agent in 40 women undergoing cesarean delivery, etomidate was present in the colostrum at both 30 minutes and 2 hours after maternal injection
Etomidrate was not present in breast milk 4 hours after the maternal dose (Esener 1992).
Does the Etomidate Manufacturer recommend using Etomidate in a breast feeding patient?
The manufacturer recommends that caution be exercised when administering etomidate to breastfeeding females; however, use is considered acceptable (Dalal 2014).
