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etomidate (Amidate)

Tradename: Amidate. Indications: - surgical &/or diagnostic procedures that do not require skeletal muscle relaxation - adjunct agent for lower potency agents such as nitric oxide - general anesthesia - for use in combination with neuromuscular blocking agent in rapid sequence endotracheal intubation [5] Contraindications: - not for sedation of patients in the intensive care unit Dosage: 1) induction 0.2-0.6 mg/kg IV over 30-60 seconds 2) may repeat as necessary 3) 10-20 ug/kg/min Injection: 2 mg/mL (10 mL, 20 mL) Pharmacokinetics: 1) rapidly distributes to body tissue 2) 76% bound to albumin 3) metabolized by liver & in blood 4) eliminated in the urine 5) terminal 1/2life is 2 hours Adverse effects: 1) common (> 10%) - nausea/vomiting - tonic-clonic movements - uncontrolled eye movements - local pain at the injection site 2) less common (1-10%) - hiccups (1-10%) 3) uncommon (< 1%) - hypertension, hypotension, bradycardia, arrhythmias, hyperventilation, hypoventilation, apnea, laryngospasm 4) other - adrenal suppression - no increase in mortality in septic patients [4,6] Drug interactions: - verapamil in combination may prolong respiratory depression & apnea Mechanism of action: 1) ultra-short acting non-barbiturate hypnotic without analgesic properties 2) less histamine release than with other agents 3) less cardiovascular & respiratory effects than with other agents

General

dissociative anesthetic

Properties

MISC-INFO: elimination route LIVER 1/2life 2 HOURS pregnancy-category C safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. Clinical Guide to Laboratory Tests, 3rd edition, NW Tietz ed, WB Saunders, Philadelphia, 1998
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Tekwani KL et al. A prospective observational study of the effect of etomidate on septic patient mortality and length of stay. Acad Emerg Med 2009 Jan; 16:11 PMID: 19055676
  5. Jabre P et al Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: A multicentre randomised controlled trial. Lancet 2009 Jul 1; PMID: 19573904 http://dx.doi.org/10.1016/S0140-6736(09)60949-1 - Wenzel V and Lindner KH. Best pharmacological practice in prehospital intubation. Lancet 2009 Jul 1; PMID: 19573905 http://dx.doi.org/10.1016/S0140-6736(09)61071-0
  6. Physician's First Watch. Feb 7, 2012 Massachusetts Medical Society McPhee LC et al. Single-dose etomidate is not associated with increased mortality in ICU patients with sepsis: Analysis of a large electronic ICU database. Crit Care Med 2013 Jan 9; PMID: 23318491