Category Archives: etomidate

Anesthesia and Pain Management for the Surgeon – Highlights – Notes

Anesthesia and Pain Management

  • PRIS – Propofol Infusion Syndrome – can be fatal.  Cardiac failure, rhabdomyolysis, and a severe metabolic acidosis.
  • Adrenal insufficiency secondary from Etomidate (induction agent) administration may be a cause of hypotension in the post op surgical patient.
  • Dexmedetomidine  (Precedex)has  analgesic properties, sedation, stable respiratory rates, predictable cardiovascular responses.
  • Ativan should not be discountinued abruptly after long term use in the ICU patient.
  • Heterotopic calcification and myopathies are complications of long term chemical paralysis – thus chemical paralysis for ventilated patients are now not as popular.
  • Pulse oximetry readings not as accurate in patients with smoke inhalation.
  • Colorimetric CO2 indicator – stomach intubation can still change the color, initially.
  • CNS and Cardiotoxity related to local anesthetic use – a concern when intercostal nerve blocks used for multiple rib fractures.  Lidocaine info
  • Place/Pull epidural catheters, won’t do unless lovenox/heparin sq held for 24 h.
  • As doses and duration of Metaclopramide (Reglan – Dopaminergic blocker) increases – neurologic side effects (movement disorders) also increases.
  • Oral to IV morphine is 3:1
  • Main use for LMA is for short cases in operating room.  There are concerns for vomiting and aspiration.


Etomidate – drug for anesthetic induction


Etomidate Vial

Background info

  • Imidazole
  • Short acting IV anesthetic
  • Hypnotic effects
  • Amnestic properties, no analgesic properties
  • works through the GABA adrenergic system
  • Used often in Rapid Sequence Intubation
  • Short duration of action, rapid onset
  • Excellent hemodynamic profile
  • Cerebroprotective effects including reduction of intracranial pressure.  Used with patients with traumatic brain injury.
  • Etomidate has hemodynamic stability which is better than all other induction agents except possibly Ketamine.
  • Post operative vomiting is more common with Etomidate than with other induction agents.
  • Requires a slow push for intubation induction otherwise one will get trismus
  • Onset of action is 30-60 seconds.

Etomidate and Adrenal Insufficiency

  • Adrenal supression:  inhibits cortisol production of the adrenal gland
  • Etomidate reversibly inhibits 11-beta-hydroxylase
  • Etomidate is no longer used for continuous sedation

Signs and Symptoms of Adrenal Insufficiency

  • Hypotension
  • Orthostatic Hypotension
  • Weakness
  • Dizziness
  • Hypoglycemia
  • Dehydration
  • Weightloss
  • Nausea
  • Vomiting
  • Diarrhea
  • Cardiovascular collapse