Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 2mg/mL
General Anesthesia Induction
0.2-0.6 mg/kg IVP over 30-60 sec
Cushing Syndrome (Off-label)
Inhibition of steroidogenesis in patients with Cushing syndrome
0.2-0.6 mg/kg IV infused over 30-60 seconds for induction of anesthesia blocks normal stress-induced increase in adrenal cortisol production for 4-8 h
ICU continuous infusion: 0.04-0.05 mg/kg/hr IV; continuous monitoring required
Dosing considerations
- Used rarely; often toxic at doses required to reduce cortisol secretion
- Long-term use limited by the requirement for repeated IV administration
Sedation (Off-label)
0.1 mg/kg IV bolus x1-3 doses; other dosing regimens may exist
Dosage Forms & Strengths
injectable solution
- 2mg/mL
General Anesthesia Induction
<10 years: Safety and efficacy not established
>10 years: Same as adults; 0.2-0.6 mg/kg IVP over 30-60 sec
Sedation (Off-label)
0.1-0.4 mg/kg IV bolus x1; additional doses may be necessary; other dosing regimens may exist
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Adverse Effects
>10%
Transient injection site pain (30-80%)
Skeletal muscle movements, mainly myoclonic (32%)
Opsoclonus (20%)
Adrenal suppression
1-10%
Hiccups
<1%
Apnea (duration: 5-90 seconds)
Arrhythmias
Hyperventilation
HTN
Hypotension
Hypoventilation
Laryngospasm
Nausea/vomiting
Oxygen desaturation
Snoring (may be associated with partial upper airway obstruction)
Warnings
Contraindications
Hypersensitivity
Cautions
Adrenal suppression (and prolonged therapy)
Prolonged infusion associated with suppression of endogenous cortisol and aldosterone production; formulation is not intended for prolonged infusion
Exacerbations of underlying myocardial dysfunction reported; monitor
Risk of toxicity may increae in patients with renal impairment; used caution; monitor renal function
Elderly patients may require lower doses; use associated with cardiac depression, especially those with hypertension
Safety during labor and delivery not elucidated; not recommended
General anesthetics and sedation drugs in young children and pregnant women
-
Brain development
- Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
- Caution with use during surgeries or procedures in children younger than 3 yr or in pregnant women during their third trimester
- Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures
Pregnancy & Lactation
Pregnancy
There are no adequate and well-controlled studies in pregnant women
There are insufficient data to support intravenous use in obstetrics, including Caesarean section deliveries; such use not recommended
Not known whether drug is excreted in human milk; because many drugs are excreted in human milk, use catuioin when administering to a nursing mother
Animal data
- In animal reproduction studies, fetal deaths and reduced pup survival were noted after intravenous administration of etomidate to pregnant rats at doses 0.17 times the human induction dose of 0.3 mg/kg
- Reduced pup survival was noted after intravenous administration of etomidate to pregnant rabbits at 1.6 times the human induction dose
- Published studies in pregnant primates demonstrate that the administration of anesthetic and sedation drugs that block NMDA receptors and/or potentiate GABA activity during the period of peak brain development increases neuronal apoptosis in developing brain of the offspring when used for longer than 3 hours
- There are no data on pregnancy exposures in primates corresponding to periods prior to third trimester in humans
Lactation
Not known whether drug is excreted in human milk; because many drugs are excreted in human milk, caution should be exercised when administered to a nursing mother.
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Nonbarbiturate hypnotic used for the induction of anesthesia; lacks analgesic activity; has minimal cardiovascular effects
Cushing syndrome (off-label): Blocks 11-beta-hydroxylase
Blocks steroidogenesis; 0.3 mg/kg will reduce plasma cortisol for up to 24 hr
Does not affect cardiac metabolism; no depression of cardiac output or of peripheral or pulmonary circulation
Absorption
Onset: Within 60 sec
Duration: 3-5 min due to redistribution from CNS
Distribution
Protein bound: 76%
Vd: 2-4.5 L/kg
Metabolism
Hepatic and plasma esterases
Elimination
Excretion: Urine, as inactive agent
Administration
IV Incompatibilities
Y-site: Ascorbic acid, vecuronium
IV Compatibilities
Syringe: Heparin
Y-site: Alfentanil, atracurium, atropine, ephedrine, fentanyl, lidocaine, lorazepam, midazolam, mivacurium, morphine sulfate, pancuronium, phenylephrine, succinylcholine, sufentanil
IV Administration
The IV infusion should be administered by healthcare professionals trained in the administration of general anesthetics and the management of complications encountered during its administration
Inject undiluted by direct IV injection over 30-60 sec; do not administer by prolonged IV infusion
Inject into large forearm vein
Consider lidocaine preadministration to minimize injection-site pain
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Patient Handout
Formulary
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