Etomidate

Etomidate

cardiovascular and respiratory depression.

Etomidate is an intravenous anaesthetic  used for induction of anaesthesia.

It has a briefer duration of action (5-10min) than thiopentone.

It produce prominent motor restlessness and rigidity, pain on injection or nausea and vomiting.

It suppress production of steroids from adrenals.

This patient is hemodynamically unstable and the induction agent of choice in this case would be etomidate,

as it is preferred in patients with unstable hemodynamics and poor cardiac reserve.

Etomidate is an induction agent which is frequently used in elderly patients, trauma victims or in emergency circumstances.

Reference:
Principles and Practice of Geriatric Surgery  edited by Ronnie Ann Rosenthal, page   315.

Etomidate when used as continuous infusion or

in repeated doses decreases the synthesis of adrenal hormones especially cortisol.

It is the commonly used sedative hypnotic in critical patients.

It causes less hypotension and tachycardia and is suitable for use in sepsis and patients with compromised cardiac function.

Ref: Essentials of Medical Pharmacology by K D Tripathi, 5th Edition, Page 343

Etomidate inhibits the enzyme, 11- hydroxylase, which is necessary for the production of cortisol, aldosterone, and corticosterone.

Even single doses of etomidate can produce adrenocortical suppression lasting 24 hours or more in healthy patients. 
Etomidate is contraindicated in patients with established or evolving septic shock because of its inhibition of cortisol synthesis.

Ref: Pharmacology and Physiology in Anesthetic Practice By Robert K. Stoelting, Simon C. Hillier, 2012, Chapter 6; Procedures and Techniques in Intensive Care Medicine, 4e By Richard S Irwin, MD, James M Rippe, M.D., 2007, Page 172.

Ans. is ‘a’ i.e., Coronary insufficiency

o Etomidate is most cardiostable inducing agent.

It can cause nausea and vomiting, decreased adrenal steroids and decrease in ICI.

Ans. is ‘b’ i.e., It precipitates coronary insufficiency

o It produces little cardiovascular and respiratory depression -4 Agent of choice for cardiovascular surgeries (bypass, aneurysms, valve surgery).

Coronary perfusion pressure is maintained when it is used with fentanyl.

A, B i.e. Thiopentone, Etomidate

B i.e. Etomidate

D. i.e. Etomidate

D i.e. Etomidate 

Ketamine and etomidate are most commonly used induction agents for (non head injury) trauma patientsQ. Ketamine is beneficial in patients with acute hypovolemic shock (d/t indirect sympathetic stimulatory effects). Whereas etomidate provides greater cardiovascular stability (ie no or minimal effects on myocardial contractility, cardiac output and cardiovascular system, mild reduction in peripheral vascular resistance and BP, and no histamine release).

Ans. c. Etomidate