Etomidate

At Etomidate it is a highly effective and primarily hypnotic drug. The substance acts on the so-called GABA receptors as well as the formatio reticularis (diffuse neural network) in the human brain. This creates sleep without developing an analgesic (i.e. pain reliever) effect. Etomidate is an anesthetic and is given to cause a comatose state for surgery (anesthesia).

What is etomidate?

Etomidate is a hypnotic substance used in human medicine. Preparations that contain the substance cause a state of sleep without having an analgesic effect. This means that sleep is triggered without any pain being satisfied.

Due to its effect, etomidate belongs to the class of anesthetics. It is administered before an operation to induce a deep sleep, in order to ensure that the treatment proceeds properly (induction of anesthesia). Etomidate is effective because it acts on the GABA receptors and the reticular formation in the human brain.

The substance is sold in Germany under the trade names Etomidat Lipuro® and Hypnomidate®. In chemistry and pharmacology it is described by the chemical formula C 14 - H 16 - N 2 - O 2. This corresponds to a moral mass of 244.29 g / mol.

The administration of etomidate is carried out, as is usual for an anesthetic, mostly parenterally, i. H. the drug is injected. The otherwise colorless, yellowish or crystalline substance without a particular odor is therefore usually traded as a solution.

Pharmacological effect

Etomidate achieves its hypnotic effect by influencing the GABA receptors in the human brain. The treated person passes out about one minute after an injection of the active substance has been administered. Depending on the dose, the duration of the effect is between 5 and 15 minutes. Multiple administration can therefore be useful.

It is important that etomidate alone does not produce complete anesthesia. Because the substance itself does not inhibit pain, which is however essential for performing an operation. Complete anesthesia, which is characterized by an absolute loss of sensations (especially the feeling of pain), is achieved only through a combination with other anesthetics or analgesics.

Etomidate does not affect the heart or the circulation as much as other drugs in the same group of active ingredients. Cardiac output usually increases slightly after the administration of etomidate as the peripheral resistance decreases slightly. However, minute ventilation decreases after administration of etomidate. If a continuous infusion is carried out, respiratory depression can develop. In addition, the active ingredient reduces the function of the adrenal cortex. The state triggered by this, however, is reversible (i.e. can be canceled).

Some patients develop myoclonus after administration of etomidate. These are short, uncontrolled twitches of the muscles. They are often suppressed by administering opioids (e.g. fentanyl).

The half-life of etomidate is 2 to 5 hours. When opioids are administered, the half-life is prolonged. The substance is mainly metabolized by the liver. The degradation is carried out renally (via the kidney) and fecally (through feces and urine).

Medical application & use

Etomidate belongs to the group of anesthetics because it causes a state of sleep. It is therefore only given to induce anesthesia. It is mainly used in high-risk patients (ASA 3 and up according to the ASA risk classification), as it is less stressful for the heart compared to other anesthetics. However, adverse effects on the heart cannot be completely ruled out even with the administration of etomidate.

Since etomidate does not have an analgesic effect, it can only be used in combination with analgesic drugs (e.g. opioids) to induce full anesthesia. These are usually given together with etomidate anyway, as the active ingredient can lead to involuntary muscle twitching (myoclonus), which can be suppressed by opioids.

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Risks & side effects

Since etomidate is an anesthetic, it should only be used by a specially trained doctor. This must be able to master endotracheal intubation, which is the case with anesthetists. The active ingredient must not be administered if it is known to be insensitive or hypersensitive.

As etomidate is excreted in breast milk, breastfeeding should not be resumed until 24 hours after administration. During pregnancy, the drug should only be administered in absolutely exceptional cases.

Etomidate can cause side effects. In particular, respiratory and circulatory impairments can occur, which is typical for anesthetics. The side effects occur in different statistical frequencies:

• Involuntary muscle movements (myoclonus) are very common (in at least 1 in 10 people). However, these are usually suppressed by giving opioids.
• Frequently (less than 1 in 10, but more than 1 in 100 patients treated), a drop in blood pressure and respiratory depression, nausea and vomiting may also occur. However, these are usually due to the administration of an opioid.
• Occasionally (affects less than 1 in 100 but more than 1 in 1,000 people) chills may occur.
• Hypersensitivity reactions and tonic-clonic convulsions are very rare (less than 1 in 10,000 patients treated).