ETOMIDATE
Introduction:
- An intravenous induction agent.
- Most cardiostable inducing agent.
Pharmacokinetic properties:
- Undergo hepatic metabolism & rapid redistribution.
Actions:
- Causes adrenal cortex suppression —> Suppresses steroidogenesis.
- ie., Suppresses release of steroids from adrenals.
- Due to 11-β-hydroxylase enzyme inhibition —> inhibiting 11-dihydroxycortisol to cortisol.
- Concurrent increase in precursors 11-dihydroxycortisol & 17-hydroxyprogesterone.
- Vitamin C restores cortisol levels.
- Produces little cardiovascular & respiratory depression.
- Maintains coronary perfusion pressure on concurrent usage with fentanyl.
Advantages:
- Is cerebro-protective – Decreases cerebral blood flow, metabolism, O2 consumption & ICT.
- Provides hemodynamic stability & maintains CPP.
Indications:
- Induction of choice for,
- For all cardiovascular surgeries (bypass, aneurysms, valve surgeries).
- RTA following splenic rupture in hemodynamically unstable cases.
- Burn case with splenic injury indicated for laparoscopy.
Contraindications:
- Acute intermittent porphyria (Etomidate & Thiopentone).
- Unsuitable for continuous IV induction in cardiac dysfunction cases – Due to suppression of steroid release.
Adverse effects:
- Cause postoperative nausea, vomiting & myoclonus.
- Highest incidence (30% – 40%) nausea & vomiting.
- Superficial thrombophlebitis.
- Pain at injection site –
- Pain reduced by injecting in larger veins & preadministration of lidocaine.
Exam Important
- Etomidate is an intravenous induction agent that suppresses steroidogenesis.
- Etomidate may cause adrenal cortex suppression.
- Etomidate causes pain at site of injection.
- In RTA following splenic rupture with hemodynamically unstablity the induction agent of choice in this case would be etomidate
- Etomidate is not suitable for continuous intravenous use in cardiac dysfunction case as it suppresses the release of steroids from adrenals
- Drugs contraindicated in acute intermittent porphyria is Etomidate & Thiopentone.
- An intravenous anesthetic agent that is associated with hemodynamic stability, maintenence of CPP with post operative nausea, vomiting and myoclonus is Etomidate.
- Burn case with splenic injury indicated for laproscopy should be given Etomidate as ideal anaesthetic agent of choice.
- Etomidate causes decrease in steroid, decrease in intracranial tension, nausea and vomiting
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