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Induction

Etomidate

Imidazole · Amidate

Mechanism: GABA-A modulator with minimal cardiovascular effects.

Calculate dose for your patient

Enter weight (kg or lb). Always verify before administration.

Computed weight
70.0 kg · 154.3 lb
Induction
14 mg – 21 mg
= 7.00–10.50 mL (2 mg/mL)
Hemodynamically stable; transient adrenal suppression.

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Full dose calculator
Onset
30–60 seconds
Duration
5–10 min
Metabolism
Hepatic esterases & plasma esterases.

Dosing

Adult
0.2–0.3 mg/kg IV
Pediatric
0.2–0.3 mg/kg IV

Indications

  • Induction in hemodynamically unstable patients
  • RSI

Contraindications

  • Known adrenal insufficiency (relative)

Side Effects

  • Myoclonus on induction
  • Adrenal cortical suppression (even single dose, ~24 h)
  • PONV (high incidence)
  • Pain on injection

Clinical Pearls

1First-line induction for the hemodynamically tenuous patient.
2Single-dose adrenal suppression rarely clinically significant — but consider in septic shock.

References & Further Reading

  1. 1
    Textbook

    Flood P, Rathmell JP, Shafer S. Stoelting's Pharmacology and Physiology in Anesthetic Practice. 5th ed. Philadelphia: Wolters Kluwer; 2015.

  2. 2
    Textbook

    Gropper MA, Miller RD, Cohen NH, et al., eds. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.

  3. 3
    Textbook

    Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, Sharar SR, Holt NF. Clinical Anesthesia. 8th ed. Philadelphia: Wolters Kluwer; 2017.

  4. 4
    Textbook

    Adriano A, Morris R, eds. 2021 CA-1 Tutorial Textbook (15th Ed.). Stanford University Medical Center, Department of Anesthesiology.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.