mjl1717
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what is it and what is mech.of action??
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| MHP
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etomidate
Etomidate is a short acting intravenous anaesthetic agent used for the induction of general anaesthesia and for sedation for short procedures such as reduction of dislocated joints and cardioversion.
Drug class
Etomidate is a carboxylated imidazole derivative. Etomidate has anesthetic and amnestic properties, but has no analgesic properties.
Uses
Etomidate has a rapid onset of action and a low cardiovascular risk profile, and therefore is less likely to cause a significant drop in blood pressure than other induction agents. Etomidate is commonly used in the emergency setting as part of a rapid sequence induction. However, in the operating room with a stable patient, anesthesiologists may choose an alternative induction agent, such as propofol, thiopental or methohexital.
Dosage
The anaesthetic induction dose for adult humans is 0.3mg/kg intravenously, with a typical dose being 20 mg. In common with all induction agents, etomidate causes loss of consciousness after one arm-brain circulation time. In very brief procedures such as cardioversion, a 10 mg dose may be used which may be repeated for effect.
Metabolism
Etomidate is highly protein bound in plasma and is metabolised by hepatic and plasma esterases to inactive products. It exhibits a bi-exponential decline, with a redistribution half-life of 2-5 minutes and an elimination half-life of 68-75 minutes.
Side effects
The use of etomidate infusions for sedation of critically ill patients in intensive care units has been associated with increased mortality, which is due to suppression of steroid synthesis (both glucocorticoids and mineralocorticoids) in the adrenal cortex. This effect has been demonstrated after a single dose, and lasts about 24 hours. There is no evidence that a single induction dose of etomidate has any effect on morbidity or mortality. However, some sources advise giving a prophylactic dose of steroids (e.g. hydrocortisone) if etomidate is used.
Excitatory phenomena, and epileptiform movements and EEG activity may be observed during induction. Etomidate consistently increases the amplitude of somatosensory evoked potentials (in contrast to most anaesthetic agents).
Etomidate in the propylene glycol formulation may produce pain on injection, a side effect which is less likely with the lipid formulation.
There is a 30-fold difference between the effective dose and the lethal dose of etomidate, making it an extremely safe agent.
Formulation
Etomidate is usually presented as a clear colourless solution for injection containing 2mg/ml of etomidate in an aqueous solution of 35% propylene glycol, although a lipid emulsion preparation (of equivalent strength) has also been introduced. Etomidate is presented as a racemic mixture, but only the D-isomer has pharmacological activity.
This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors
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