Etomidate is an ultrashort-acting, non-barbiturate hypnotic intravenous anesthetic agent. Is one of the most used and preferred hypnotic agents in the ED for Rapid Sequence Intubation (RSI)(29).
Etomidate is an imidazole derivative, with agonist activity to the β2 and β3 subunits of the GABA receptor (11) increasing its activity by moderating chloride channels, inhibiting neuronal action by decreasing the action potential threshold (16, 23, 28, 29).
US-FDA Labeled (34, 4):
Inductor dose for rapid sequence intubation
0.3 mg/kg IV.
Calculate with total body weight.
No renal or hepatic adjustments needed.
Etomidate (worldwide generic formulation) 20mg/10ml, IV use.
Pregnancy Risk Factor Category (US-FDA): C.
Data shows that the use of general anaesthetics (GABA enhancers, NMDA blockers, other sedatives) in the third trimester of pregnancy could lead to long-term brain damage in the fetus (30). There are no available controlled studies of etomidate use in pregnant women. Its use in pregnancy should be evaluated with caution and always as a single dose if elected among other inductor agents.
Consider use of propofol for induction in pregnant women (US-FDA Pregnancy Risk Factor Category B).
(2, 4, 5, 9, 16, 23, 28, 29).