Drug reference
Induction of anaesthesia ▶BY SLOW INTRAVENOUS INJECTION ▶Adult: 150–300 micrograms/kg (max. per dose 60 mg), to be administered over 30-60 seconds (60 seconds in patients in whom hypotension might be hazardous) ▶Elderly: 150–200 micrograms/kg (max. per dose 60 mg), to be administered over 30-60 seconds (60 seconds in Anaesthesia patients in whom hypotension might be hazardous)
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Acute circulatory failure (shock). adrenal insufficiency. Avoid in Acute porphyrias p. 1120. cardiovascular disease. elderly. fixed cardiac output. hypovolaemia CAUTIONS, FURTHER INFORMATION ▶Adrenal insufficiency Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia. It should be used with caution in patients with underlying adrenal insufficiency, for example, those with sepsis.
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Etomidate should only be administered by, or under the direct supervision of, personnel experienced in its use, with adequate training in anaesthesia and airway management, and when resuscitation equipment is available.
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→Appendix 1: etomidate
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▶Common or very common Apnoea. hypotension. movement disorders. nausea. respiratory disorders. skin reactions. vascular pain. vomiting ▶Uncommon Arrhythmias. cough. hiccups. hypersalivation . hypertension. muscle rigidity. neuromuscular dysfunction. nystagmus. procedural complications ▶Frequency not known Adrenal insufficiency. atrioventricular block. cardiac arrest. embolism and thrombosis. seizures. shock. Stevens-Johnson syndrome. trismus SIDE-EFFECTS, FURTHER INFORMATION Pain on injection Can be reduced by injecting into a larger vein or by giving an opioid analgesic just before induction. Extraneous muscle movements Extraneous muscle movements can be minimised by an opioid analgesic or a short-acting benzodiazepine given just before induction.
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May depress neonatal respiration if used during delivery.
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Breast-feeding can be resumed as soon as mother has recovered sufficiently from anaesthesia.
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Dose adjustments Manufacturer advises reduce dose in liver cirrhosis.
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To be administered over 30–60 seconds (60 seconds in patients in whom hypotension might be hazardous).
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection EXCIPIENTS: May contain Propylene glycol ▶Hypnomidate (Piramal Critical Care Ltd) Etomidate 2 mg per 1 ml Hypnomidate 20mg/10ml solution for injection ampoules | 5 ampoule P £6.90 Emulsion for injection ▶Etomidate-Lipuro (B.Braun Medical Ltd) Etomidate 2 mg per 1 ml Etomidate-Lipuro 20mg/10ml emulsion for injection ampoules | 10 ampoule P £16.09
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Driving and skilled tasks Patients given sedatives and analgesics during minor outpatient procedures should be very carefully warned about the risk of driving or undertaking skilled tasks afterwards. For a short general anaesthetic the risk extends to at least 24 hours after administration. Responsible persons should be available to take patients home. The dangers of taking alcohol should also be emphasised.
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150–300 micrograms/kg (max. per dose 60 mg),
First-line fragment. Read the complete Indications and Dose section above.
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