Etomidate: An Intravenous Induction Agent Offering Hemodynamic Stability but Limited by Adrenal Suppression Concerns

 🧠 Introduction to Etomidate

Etomidate, introduced in the 1970s, is a non-barbiturate intravenous anesthetic used for induction of anesthesia. It is particularly useful in patients with cardiac disease or unstable hemodynamics, as it causes minimal cardiovascular depression compared to other agents.

⚙️ Mechanism of Action

Etomidate works by enhancing GABA-A receptor activity, leading to increased chloride influx, neuronal hyperpolarization, and central nervous system depression. This produces sedation, hypnosis, and anesthesia, but unlike ketamine or propofol, it provides no analgesia.

🩺 Clinical Uses

Induction of anesthesia in patients with cardiovascular compromise

Rapid sequence induction in hemodynamically unstable patients

Procedural sedation in selected critical care situations

Its rapid onset and short duration make it suitable for emergency use.

⚠️ Side Effects and Risks

Adrenal suppression due to inhibition of 11-β hydroxylase enzyme

Myoclonus and involuntary muscle movements during induction

Postoperative nausea and vomiting

Pain on injection if not given with lidocaine

🧪 Pharmacological Properties

Onset: 30–60 seconds

Duration: 5–10 minutes

Metabolism: Hepatic and plasma esterases

Elimination: Primarily renal excretion

🧾 Conclusion

Etomidate is a valuable anesthetic induction drug in high-risk cardiac or unstable patients. However, its use is restricted by concerns of adrenal suppression and lack of analgesic properties, making it best suited for specific clinical scenarios rather than routine anesthesia practice.

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