What is the role of etomidate (Amidate) in procedural sedation and analgesia (PSA)?

Updated: Sep 21, 2020
  • Author: Alma N Juels, MD; Chief Editor: Erik D Schraga, MD  more...
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Etomidate (Amidate) is an ultra–short-acting nonbarbiturate hypnotic used for anesthesia. It produces rapid induction without histamine release and with minimal cardiovascular and respiratory effects. As with ketamine or barbiturates, etomidate transiently lowers cerebral blood flow by 20-30% and slightly reduces intracranial and intraocular pressure. It has no analgesic properties. Onset of action is 5-30 seconds with peak action at 1 minute. Etomidate has a duration of 2-10 minutes depending on the dose. The major adverse effect is transient adrenal suppression secondary to inhibition of 11-ß-hydroxylase and 17-alpha-hydroxylase enzymes which are important in cortisol synthesis. There is also a high incidence of pain on injection and nausea and vomiting associated with bolus administration.

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