Etomidate cardiovascular effects

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 (ti/23 = 2.9 hours), in addition to its use as an induc-... 

Etomidate, when administered as the sole agent, produces little effect on cardiovascular function. It produces a slight reduction in systemic pressure and an increase in heart rate. Myocardial oxygen consumption is not significantly affected by etomidate. The drug does not release histamine and can be safely used in the presence of cardiorespiratory disease. 

Etomidate is a carboxylated imidazole that can be used for induction of anesthesia in patients with limited cardiovascular reserve. Its major advantage over other intravenous anesthetics is that it causes minimal cardiovascular and respiratory depression. Etomidate produces a rapid loss of consciousness, with minimal hypotension even in elderly patients with poor cardiovascular reserve. The heart rate is usually unchanged, and the incidence of apnea is low. The drug has no analgesic effects, and coadministration of opioid analgesics is required to decrease cardiac responses during tracheal intubation and to lessen spontaneous muscle movements. Following an induction dose, initial recovery from etomidate is less rapid (< 10 minutes) compared with recovery from propofol. 

Finally, newer intravenous anesthetics such as etomidate (Amidate) and propofol (Diprivan) are available. Etomidate is a hypnoticlike drug that causes a rapid onset of general anesthesia with a minimum of cardiopulmonary side effects. Flence, this drug may be useful in patients with compromised cardiovascular or respiratory function. Propofol is a short-acting hypnotic that is useful as a general anesthetic in some... 

Another nonbarbiturate anesthetic is the imidazole carboxylate etomidate. Even though it produces no analgesia, it is used with fentanyl (see later) to produce very rapid anesthesia induction. The drug s appeal is its minimal effect on respiration and the cardiovascular system. Unlike many of the volatile compounds, it produces no annoying histamine release. It does cause intermittent muscle twitching. 

Cardiovascular Cardiovascular stability after induction is a major advantage of etomidate over either barbiturates or propofol. Induction doses of etomidate typically produce a small increase in heart rate and little or no decrease in blood pressure or cardiac output. Etomidate has little effect on coronary perfusion pressure while reducing myocardial consumption. Thus, of all induction agents, etomidate is best suited to maintain cardiovascular stability in patients with coronary artery disease, cardiomyopathy, cerebral vascular disease, or hypovolemia. 

The most important side effects of etomi-date are involuntary muscle movements and pain at the site of injection (57 -, 58 ). Although one patient with a skin rash (without other symptoms of allergy) after the use of etomidate is described the statement that etomidate causes no allergic reactions still probably holds true, since no skin tests were performed and many other drugs were given. The cardiovascular stability after its use is remarkable (55, 57, 58 ). 

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