Chapter: Modern Pharmacology with Clinical Applications: General Anesthesia: Intravenous and Inhalational Agents

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Etomidate

The pharmacological properties of etomidate (Amidate) are similar to those of the barbiturates, although its use may provide a greater margin of safety because of its limited effects on the cardiovascular and respiratory systems.

Etomidate

The pharmacological properties of etomidate (Amidate) are similar to those of the barbiturates, although its use may provide a greater margin of safety because of its limited effects on the cardiovascular and respiratory systems. Since it has a relatively short elimination half-life (t1/2 2.9 hours), in addition to its use as an induc- tion agent, etomidate has been used as a supplement to maintain anesthesia in some critically ill patients. Etomidate is rapidly hydrolyzed in the liver.

Pharmacological Actions

A primary advantage of etomidate is its ability to pre-serve cardiovascular and respiratory stability; both car-diac output and diastolic pressure are well maintained. Use of etomidate may offer some advantage to the pa-tient with compromised myocardial oxygen or blood supply or both, since it produces mild coronary vasodi-lation. Thus, coronary vascular resistance decreases with no change in perfusion pressure. Preservation of dia-stolic perfusion pressure may be particularly important when myocardial blood supply cannot be increased by autoregulation.

Adverse Effects

Etomidate may cause pain on injection and may pro-duce myoclonic muscle movements in approximately 40% of patients during its use as an induction anesthetic. In addition, etomidate can suppress the adrenocortical response to stress, an effect that may last up to 10 hours.

 

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