Etomidate

Also called Amidate, it's a VERY strong sedative that lasts for about 5 minutes. We use it for almost all intubations in the ER, usual dose is 20 mg IVP(the whole ampule). Occasionally we'll use a lower dose (10 mg) for conscious sedation as well, with an RT standing at bedside to protect airway because the pt can definitely stop breathing.

Etomidate is a non-barbiturate hypnotic with out analgesic activity. It increases the GABA-A receptor for GABA, thus leading to a depression of the reticular activating system. It is primarily used for the induction of anesthesia and/or tracheal intubation. It offers the greatest cardiovascular stability of all of the IV induction agents. It should only be administered by somebody trained in airway management, as a patient will go apneic! It is generally dosed as 0.2-0.5 mg/kg, has an onset of action of 30-60 sec, and a return to consciousness in 3-10 minutes. It burns when injected, may cause N/V, causes adrenocortical suppression, and should not be given to patients with a seizure history. I would continue, but I'd rather not bore you.

Also called Amidate, it's a VERY strong sedative that lasts for about 5 minutes. We use it for almost all intubations in the ER, usual dose is 20 mg IVP(the whole ampule). Occasionally we'll use a lower dose (10 mg) for conscious sedation as well, with an RT standing at bedside to protect airway because the pt can definitely stop breathing.

Etomidate is intended for induction of anesthesia, NOT conscious sedation.

Etomidate is intended for induction of anesthesia, NOT conscious sedation.

We give etomidate prior to elective cardioversion.

We give etomidate prior to elective cardioversion.

How much are you giving? Do you have problems with the muscle twitching with the doses you're using?

And why not just use propofol? It's superb for cardioversion.

How much are you giving? Do you have problems with the muscle twitching with the doses you're using?

And why not just use propofol? It's superb for cardioversion.

We usually give between 6-10cc...we don't use propofol routinely for cardioversion because a good chunk of the patients we are cardioverting are extubated. I am just beginning CRNA school so I am only familiar with using propofol for continuous sedation in a CTICU, not for procedural sedation. Maybe because of the cost? I know that propofol is quite expensive, but I am not sure of the cost of etomidate.

I have never seen problems with muscle twitching for my patients.

After a couple of weeks of anesthesia school, I know why my unit uses etomidate instead of propofol:-) Etomidate has less effects on the LV function, whereas propofol depresses myocardial contractility, especially in the left ventricle. The patient population I worked with was surgical heart failure, so we don't want to depress someone whose EF is only 10-15%!

Using propofol for elective cardioversion may be ok in other settings though, where the LV isn't so fragile.

After a couple of weeks of anesthesia school, I know why my unit uses etomidate instead of propofol:-) Etomidate has less effects on the LV function, whereas propofol depresses myocardial contractility, especially in the left ventricle. The patient population I worked with was surgical heart failure, so we don't want to depress someone whose EF is only 10-15%!

Using propofol for elective cardioversion may be ok in other settings though, where the LV isn't so fragile.

We don't use much propofol for cardioversions. Often 30-40mg is enough in a fair number of our patients. I start with 20, wait about 30sec, then give 10mg every 15-30sec until they start "batting their eyes". When they don't respond to verbal stimuli and a shake on the shoulder, they get zapped. We haven't seen any problems with this technique in all the years we've used it at our facility, HOWEVER I will qualify that by saying that these are semi-elective cardioversions on outpatients, and not urgent ones in the ICU. We don't even get called for those.

What is this stuff? I see it in the frig at my new job, but I can't find anything about it in my books, and I haven't seen it used yet! I have lots of emergency experience, but no anesthesia or surgical background.

You can view the pkg insert for more detailed information at:

http://www.bedfordlabs.com/pdf/762-10.pdf

We usually use both etomidate and propofol bolus to intubate in my MICU. Seems to mostly work well except the times when we need a paralytic as well.