etomidate (Amidate)
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Introduction
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
Injection: 2 mg/mL (10 mL, 20 mL)
Pharmacokinetics
- rapidly distributes to body tissue
- 76% bound to albumin
- metabolized by liver & in blood
- eliminated in the urine
- terminal 1/2life is 2 hours
elimination via liver
1/2life = 2 hours
Adverse effects
- common (> 10%)
- nausea/vomiting
- tonic-clonic movements
- uncontrolled eye movements
- local pain at the injection site
- less common (1-10%)
- hiccups (1-10%)
- uncommon (< 1%)
- 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
- ultra-short acting non-barbiturate hypnotic without analgesic properties
- less histamine release than with other agents
- less cardiovascular & respiratory effects than with other agents
More general terms
References
- ↑ Clinical Guide to Laboratory Tests, 3rd edition, NW Tietz ed, WB Saunders, Philadelphia, 1998
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 4.0 4.1 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: https://www.ncbi.nlm.nih.gov/pubmed/19055676
- ↑ 5.0 5.1 Jabre P et al Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: A multicentre randomised controlled trial. Lancet 2009 Jul 1; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19573904 <Internet> 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; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19573905 <Internet> http://dx.doi.org/10.1016/S0140-6736(09)61071-0 - ↑ 6.0 6.1 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: https://www.ncbi.nlm.nih.gov/pubmed/23318491