What is the role of etomidate in emergency department (ED) sedation?

Updated: Nov 06, 2018
  • Author: Arul M Lingappan, MD; Chief Editor: Erik D Schraga, MD  more...
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Etomidate is an imidazole derivative compound with sedative properties. Administered intravenously, etomidate has rapid onset of action (< 1 min) and a short but dose-dependent duration of action (5-8 min). A major feature of this agent is that cardiovascular effects are negligible during deep sedation. It may cause transient neuromuscular twitching that is sometimes confused with seizure activity. One study showed that pretreatment with magnesium sulfate may prevent etomidate-induced myoclonus. [13]

Its major application is induction for endotracheal intubation, especially for patients at risk for hemodynamic compromise. The recommended dose for intubation is 0.3 mg/kg in adults and children, although the dose may be reduced to 0.15 mg/kg in critically ill patients. It can be also be used in procedures as a one-time dose. Etomidate has been shown to depress adrenal cortical function in critically ill patients, [14, 15] but this may not be clinically significant in short-term administration. [16] Because of this effect and because the drug is mixed in propylene glycol, neither titration nor continuous infusion is recommended.

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