IV hypnotic
Etomidate
Amidate Induction agent — yellow 2 mg/mL
The hemodynamically gentle induction agent — at the cost of adrenal suppression.
Typical adult doses
| Indication | Dose | Onset | Duration |
|---|---|---|---|
| Induction | 0.2–0.3 mg/kg IV (label 0.2–0.6) | 30–60 s | 3–5 min |
Mechanism
GABA-A receptor modulation.
Key effects
- Minimal cardiovascular depression
- No analgesia
- Myoclonus (can mimic seizure)
Watch out for
- Adrenal suppression — inhibits 11β-hydroxylase, even after one dose
- PONV
- Pain on injection
Pimp questions
Pimp question 1
How does etomidate suppress the adrenals?
Answer
It inhibits 11β-hydroxylase, reducing cortisol synthesis.
Pimp question 2
Why choose etomidate?
Answer
Hemodynamic stability in patients who can’t tolerate a drop in blood pressure.