How does etomidate cause adrenal suppression?

A well-documented side effect of etomidate is suppression of the adrenal synthesis of cortisol. In a dosedependent fashion, it inhibits adrenal mitochondrial 11-β hydroxylase, the enzyme responsible for the final conversion of 11-deoxycortisol to cortisol (Figure 1).

How does etomidate work?

Etomidate acts on the CNS to stimulate gamma-aminobutyric acid (GABA) receptors and, in doing so, depresses the reticular activating system. The electroencephalogram (EEG) changes are similar to those produced by barbiturates as the patient passes rapidly through light to deep levels of surgical anesthesia.

Does etomidate cause hypotension?

Some 19.5% of patients had hypotension after being given midazolam while only 3.6% with etomidate (p = 0.002). Patients older than 70 tended to have more hypotension episodes but the difference was not statistically significant.

Why is etomidate contraindicated in septic shock?

Unfortunately, etomidate causes relative adrenal insufficiency in up to 90% of patients after a single dose (3). Serious safety concerns first surfaced in the early 1980’s when continuous infusions were associated with increased mortality in trauma patients (4,5).

When should you not use etomidate?

Etomidate should therefore be avoided as an induction agent in critical illness, in particular in patients with septic shock, among whom the incidence of adrenal insufficiency is high [19–21].

What is etomidate and sux?

Succinylcholine and etomidate are the standard medications used for rapid sequence intubation (RSI) and were the medications used in all of the ED RSI we examined.

What is the antidote for etomidate?

Conclusions: Etomidate resulted in stable hemodynamic responses and relatively less adverse effects, and flumazenil antagonized the anesthetic effect of etomidate; thus, etomidate with flumazenil is suitable for performing stem cell transplantation in autistic children.

What does etomidate and sux do?

Succinylcholine and etomidate are the standard medications used for rapid sequence intubation (RSI) and were the medications used in all of the ED RSI we examined. We entered de-identified data into a Microsoft Excel 2003 (Redmond, WA) database.

Does versed lower BP?

Midazolam does not affect BP or HR.

When should you not give etomidate?

Its use by infusion in trauma patients has been associated with an increase in mortality [16, 17] and has led to recommendations not to use etomidate in trauma patients [18].