etomidate

Summary

Summary: Imidazole derivative anesthetic and hypnotic with little effect on blood gases, ventilation, or the cardiovascular system. It has been proposed as an induction anesthetic.

Top Publications

  1. Meera P, Olsen R, Otis T, Wallner M. Etomidate, propofol and the neurosteroid THDOC increase the GABA efficacy of recombinant alpha4beta3delta and alpha4beta3 GABA A receptors expressed in HEK cells. Neuropharmacology. 2009;56:155-60 pubmed publisher
    ..Considering the demonstrated importance of GABA receptor beta3 subunits for in vivo anesthetic effects of etomidate and propofol, we decided to investigate the effects of GABA anesthetics on "extrasynaptic" ..
  2. Li G, Chiara D, Sawyer G, Husain S, Olsen R, Cohen J. Identification of a GABAA receptor anesthetic binding site at subunit interfaces by photolabeling with an etomidate analog. J Neurosci. 2006;26:11599-605 pubmed
    General anesthetics, including etomidate, act by binding to and enhancing the function of GABA type A receptors (GABA(A)Rs), which mediate inhibitory neurotransmission in the brain...
  3. Hahner S, Sturmer A, Fassnacht M, Hartmann R, Schewe K, Cochran S, et al. Etomidate unmasks intraadrenal regulation of steroidogenesis and proliferation in adrenal cortical cell lines. Horm Metab Res. 2010;42:528-34 pubmed publisher
    To characterize intraadrenal adaptations for inhibition of cortisol synthesis, we analyzed the effects of etomidate (ETO) on steroid hormone secretion and expression of key regulators of steroidogenesis and proliferation in human NCI-..
  4. Banh K, James S, Hendey G, Snowden B, Kaups K. Single-dose etomidate for intubation in the trauma patient. J Emerg Med. 2012;43:e277-82 pubmed publisher
    Concerns over adrenal suppression caused by a single dose of etomidate for intubation led to limiting its use in trauma patients in 2006...
  5. O Meara G, Newman R, Fradley R, Dawson G, Reynolds D. The GABA-A beta3 subunit mediates anaesthesia induced by etomidate. Neuroreport. 2004;15:1653-6 pubmed
    The i.v. agent etomidate exerts its anaesthetic actions through potentiation of gamma-aminobutyric acid-A receptors containing beta2 and beta3 subunits...
  6. Cherfan A, Arabi Y, Al Dorzi H, Kenny L. Advantages and disadvantages of etomidate use for intubation of patients with sepsis. Pharmacotherapy. 2012;32:475-82 pubmed publisher
    b>Etomidate is a potent imidazole hypnotic used widely in single doses in the rapid sequence intubation of critically ill patients with sepsis due to its presumed hemodynamic safety, fast onset, and short duration of action...
  7. Cotten J, Le Ge R, Banacos N, Pejo E, Husain S, Williams J, et al. Closed-loop continuous infusions of etomidate and etomidate analogs in rats: a comparative study of dosing and the impact on adrenocortical function. Anesthesiology. 2011;115:764-73 pubmed publisher
    b>Etomidate is a sedative-hypnotic that is often given as a single intravenous bolus but rarely as an infusion because it suppresses adrenocortical function...
  8. Mizrak A, Koruk S, Bilgi M, Kocamer B, Erkutlu I, Ganidagli S, et al. Pretreatment with dexmedetomidine or thiopental decreases myoclonus after etomidate: a randomized, double-blind controlled trial. J Surg Res. 2010;159:e11-6 pubmed publisher
    Myoclonic movements are common problems during induction of anesthesia with etomidate. The aim of this study was to compare the effect of pretreatment with dexmedetomidine (0...
  9. Jackson W. Should we use etomidate as an induction agent for endotracheal intubation in patients with septic shock?: a critical appraisal. Chest. 2005;127:1031-8 pubmed
    b>Etomidate is commonly used for the facilitation of endotracheal intubation...

More Information

Publications62

  1. Chiara D, Dostalova Z, Jayakar S, Zhou X, Miller K, Cohen J. Mapping general anesthetic binding site(s) in human ?1?3 ?-aminobutyric acid type A receptors with [³H]TDBzl-etomidate, a photoreactive etomidate analogue. Biochemistry. 2012;51:836-47 pubmed publisher
    ..H]azietomidate photolabeling of ?Met-236 and ?Met-286 in the ?M1 and ?M3 transmembrane helices identified an etomidate binding site in the GABA(A)R transmembrane domain at the interface between the ? and ? subunits [Li, G. D., et...
  2. Seymour V, Curmi J, Howitt S, Casarotto M, Laver D, Tierney M. Selective modulation of different GABAA receptor isoforms by diazepam and etomidate in hippocampal neurons. Int J Biochem Cell Biol. 2012;44:1491-500 pubmed publisher
    ..In this study we have tested this hypothesis by potentiating extrasynaptic GABA(A) currents with etomidate and examining the ability of peptides mimicking either the ?2- or ?-subunit MA region to affect conductance...
  3. Kretschmannova K, Hines R, Revilla Sanchez R, Terunuma M, Tretter V, Jurd R, et al. Enhanced tonic inhibition influences the hypnotic and amnestic actions of the intravenous anesthetics etomidate and propofol. J Neurosci. 2013;33:7264-73 pubmed publisher
    ..enhancement of tonic inhibition in the dentate gyrus that was more sensitive to modulation by the anesthetic etomidate, together with a deficit in long-term potentiation...
  4. Bloomfield R, Noble D. Exploring the role of etomidate in septic shock and acute respiratory distress syndrome. Crit Care Med. 2006;34:1858; author reply 1858-9 pubmed
  5. Cuthbertson B, Sprung C, Annane D, Chevret S, Garfield M, Goodman S, et al. The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock. Intensive Care Med. 2009;35:1868-76 pubmed publisher
    Use of etomidate in the critically ill is controversial due to its links with an inadequate response to corticotropin and potential for excess mortality...
  6. Iribarren J, Jimenez J, Hernandez D, Lorenzo L, Brouard M, Milena A, et al. Relative adrenal insufficiency and hemodynamic status in cardiopulmonary bypass surgery patients. A prospective cohort study. J Cardiothorac Surg. 2010;5:26 pubmed publisher
    ..Prospective cohort study on cardiopulmonary bypass patients who received etomidate or not during anesthetic induction...
  7. Husain S, Stewart D, Desai R, Hamouda A, Li S, Kelly E, et al. p-Trifluoromethyldiazirinyl-etomidate: a potent photoreactive general anesthetic derivative of etomidate that is selective for ligand-gated cationic ion channels. J Med Chem. 2010;53:6432-44 pubmed publisher
    ..trifluoromethyldiazirinyl-etomidate), or TFD-etomidate, a novel photoactivable derivative of the stereoselective general anesthetic etomidate (R-(2-..
  8. Stewart D, Desai R, Cheng Q, Liu A, Forman S. Tryptophan mutations at azi-etomidate photo-incorporation sites on alpha1 or beta2 subunits enhance GABAA receptor gating and reduce etomidate modulation. Mol Pharmacol. 2008;74:1687-95 pubmed publisher
    The potent general anesthetic etomidate produces its effects by enhancing GABA(A) receptor activation...
  9. Morris C, McAllister C. Etomidate for emergency anaesthesia; mad, bad and dangerous to know?. Anaesthesia. 2005;60:737-40 pubmed
  10. Kim T, Rhee J, Kim K, Cha W, Suh G, Jung S. Etomidate should be used carefully for emergent endotracheal intubation in patients with septic shock. J Korean Med Sci. 2008;23:988-91 pubmed publisher
    b>Etomidate and midazolam are the most popular drugs among the induction agents for emergent endotracheal intubation...
  11. Ray D, McKeown D. Effect of induction agent on vasopressor and steroid use, and outcome in patients with septic shock. Crit Care. 2007;11:R56 pubmed
    In seriously ill patients, etomidate gives cardiovascular stability at induction of anaesthesia, but there is concern over possible adrenal suppression...
  12. Cheng V, Martin L, Elliott E, Kim J, Mount H, Taverna F, et al. Alpha5GABAA receptors mediate the amnestic but not sedative-hypnotic effects of the general anesthetic etomidate. J Neurosci. 2006;26:3713-20 pubmed
    ..alpha5 subunit (alpha5GABAARs) play a critical role in amnesia caused by the prototypic intravenous anesthetic etomidate. Whole-cell recordings from hippocampal pyramidal neurons showed that etomidate markedly increased a tonic ..
  13. Pejo E, Feng Y, Chao W, Cotten J, Le Ge R, Raines D. Differential effects of etomidate and its pyrrole analogue carboetomidate on the adrenocortical and cytokine responses to endotoxemia. Crit Care Med. 2012;40:187-92 pubmed publisher
    We developed a novel pyrrole analog of etomidate, (R)-ethyl 1-(1-phenylethyl)-1H-pyrrole-2-carboxylate (carboetomidate), which retains etomidate's desirable anesthetic and hemodynamic properties but lacks its potent inhibitory affect on ..
  14. Oglesby A. Should etomidate be the induction agent of choice for rapid sequence intubation in the emergency department?. Emerg Med J. 2004;21:655-9 pubmed
    ..This review was performed to ascertain whether etomidate should be the induction agent of choice for rapid sequence intubation (RSI) in the emergency department, ..
  15. Zolle I, Berger M, Hammerschmidt F, Hahner S, Schirbel A, Peric Simov B. New selective inhibitors of steroid 11beta-hydroxylation in the adrenal cortex. Synthesis and structure-activity relationship of potent etomidate analogues. J Med Chem. 2008;51:2244-53 pubmed publisher
    Derivatives of etomidate were evaluated as inhibitors of adrenal steroid 11beta-hydroxylations...
  16. Drexler B, Roether C, Jurd R, Rudolph U, Antkowiak B. Opposing actions of etomidate on cortical theta oscillations are mediated by different gamma-aminobutyric acid type A receptor subtypes. Anesthesiology. 2005;102:346-52 pubmed
    ..The authors ask how etomidate, acting predominantly via gamma-aminobutyric acid type A (GABAA) receptors containing beta2 or beta3 subunits, ..
  17. Di Liddo L, D Angelo A, Nguyen B, Bailey B, Amre D, Stanciu C. Etomidate versus midazolam for procedural sedation in pediatric outpatients: a randomized controlled trial. Ann Emerg Med. 2006;48:433-40, 440.e1 pubmed
    Midazolam is widely used for procedural sedation and analgesia. Etomidate has been studied mostly in adults. Our objective is to compare the efficacy of etomidate and midazolam for achieving procedural sedation and analgesia in children...
  18. Cirone J, Rosahl T, Reynolds D, Newman R, O Meara G, Hutson P, et al. Gamma-aminobutyric acid type A receptor beta 2 subunit mediates the hypothermic effect of etomidate in mice. Anesthesiology. 2004;100:1438-45 pubmed
    ..acid type A (GABAA) receptor beta 2N265S mutation results in a knock-in mouse with reduced sensitivity to etomidate. After recovery from etomidate anesthesia, these mice have improved motor performance and less slow wave sleep...
  19. Warner K, Cuschieri J, Jurkovich G, Bulger E. Single-dose etomidate for rapid sequence intubation may impact outcome after severe injury. J Trauma. 2009;67:45-50 pubmed publisher
    b>Etomidate is an induction agent used for the rapid sequence intubation (RSI) of trauma patients because of its favorable hemodynamic profile and rapid onset...
  20. Liu H, Zeng H, Cheng H, Wang M, Qiao H, Han R. Comparison of the effects of etomidate and propofol combined with remifentanil and guided by comparable BIS on transcranial electrical motor-evoked potentials during spinal surgery. J Neurosurg Anesthesiol. 2012;24:133-8 pubmed publisher
    ..There are fewer reports comparing the effects of etomidate and propofol infusion on TceMEPs when used for the maintenance of anesthesia and guided by comparable values of ..
  21. Hüter L, Schreiber T, Gugel M, Schwarzkopf K. Low-dose intravenous midazolam reduces etomidate-induced myoclonus: a prospective, randomized study in patients undergoing elective cardioversion. Anesth Analg. 2007;105:1298-302, table of contents pubmed
    Myoclonic movements are a common problem in unpremedicated patients during induction of anesthesia with etomidate.
  22. Andrada J, Livingston P, Lee B, ANTOGNINI J. Propofol and etomidate depress cortical, thalamic, and reticular formation neurons during anesthetic-induced unconsciousness. Anesth Analg. 2012;114:661-9 pubmed publisher
    ..Likely sites include the cerebral cortex, thalamus, and reticular formation. We examined the effects of propofol and etomidate on neuronal function in the cortex, thalamus, and reticular formation in intact animals.
  23. Murray H, Marik P. Etomidate for endotracheal intubation in sepsis: acknowledging the good while accepting the bad. Chest. 2005;127:707-9 pubmed
  24. Choi Y, Wong T, Lau C. Midazolam is more likely to cause hypotension than etomidate in emergency department rapid sequence intubation. Emerg Med J. 2004;21:700-2 pubmed
    To compare the haemodynamic effect of low dose midazolam and etomidate as induction agent in emergency department rapid sequence intubation. A prospective observational study in two phases...
  25. Bilehjani E, Kianfar A, Toofan M, Fakhari S. Anesthesia with etomidate and remifentanil for cesarean section in a patient with severe peripartum cardiomyopathy--a case report. Middle East J Anaesthesiol. 2008;19:1141-9 pubmed
    ..Remifentanil was used safely in peripartum cardiomyopathic patients, but there is not any report about etomidate usage in such patients...
  26. Harman F, Hasturk A, Yaman M, Arca T, Kilinc K, Sargon M, et al. Neuroprotective effects of propofol, thiopental, etomidate, and midazolam in fetal rat brain in ischemia-reperfusion model. Childs Nerv Syst. 2012;28:1055-62 pubmed publisher
    The aim of this study was to investigate the neuroprotective effects of propofol, thiopental, etomidate, and midazolam as anesthetic drugs in fetal rat brain in the ischemia-reperfusion (IR) model...
  27. Liao M, Sonner J, Husain S, Miller K, Jurd R, Rudolph U, et al. R (+) etomidate and the photoactivable R (+) azietomidate have comparable anesthetic activity in wild-type mice and comparably decreased activity in mice with a N265M point mutation in the gamma-aminobutyric acid receptor beta3 subunit. Anesth Analg. 2005;101:131-5, table of contents pubmed
    A photoactivable diazirine derivative of etomidate, azietomidate, shares many actions of etomidate, including a capacity to abolish the righting reflexes in tadpoles and enhance gamma-aminobutyric acid (GABA)-induced currents...
  28. Gultop F, Akkaya T, Bedirli N, Gumus H. Lidocaine pretreatment reduces the frequency and severity of myoclonus induced by etomidate. J Anesth. 2010;24:300-2 pubmed publisher
    ..study was to assess the effects of lidocaine on the incidence and severity of myoclonic movements induced by etomidate. Sixty patients were randomly assigned to receive either 20 mg lidocaine or saline (n = 30, each), 30 s before ..
  29. den Brinker M, Hokken Koelega A, Hazelzet J, de Jong F, Hop W, Joosten K. One single dose of etomidate negatively influences adrenocortical performance for at least 24h in children with meningococcal sepsis. Intensive Care Med. 2008;34:163-8 pubmed
    To investigate the effect of one single bolus of etomidate used for intubation on adrenal function in children with meningococcal sepsis. Retrospective study conducted between 1997 and 2004...
  30. Werner D, Blednov Y, Ariwodola O, Silberman Y, Logan E, Berry R, et al. Knockin mice with ethanol-insensitive alpha1-containing gamma-aminobutyric acid type A receptors display selective alterations in behavioral responses to ethanol. J Pharmacol Exp Ther. 2006;319:219-27 pubmed
    ..we observed that mutant mice recovered more quickly from the motor-impairing effects of ethanol and etomidate, but not pentobarbital, and showed increased anxiolytic effects of ethanol...
  31. Bloomfield R, Noble D. Etomidate and fatal outcome--even a single bolus dose may be detrimental for some patients. Br J Anaesth. 2006;97:116-7 pubmed
  32. Albert S, Ariyan S, Rather A. The effect of etomidate on adrenal function in critical illness: a systematic review. Intensive Care Med. 2011;37:901-10 pubmed publisher
    Although etomidate is a preferred anesthetic agent for rapid sequence intubation (RSI) in critical illness, as an inhibitor of cortisol synthesis (11?-hydroxylase), it may be associated with adrenal dysfunction...
  33. Voss L, Baas C, Hansson L, Li D, Sleigh J. Investigation into the effect of the general anaesthetic etomidate on local neuronal synchrony in the mouse neocortical slice. Brain Res. 2013;1526:65-70 pubmed publisher
    ..In this study we investigated whether the intravenous anaesthetic etomidate synchronises neuronal activity on a sub-millimetre scale in mouse neocortical slices...
  34. Butovas S, Rudolph U, Jurd R, Schwarz C, Antkowiak B. Activity patterns in the prefrontal cortex and hippocampus during and after awakening from etomidate anesthesia. Anesthesiology. 2010;113:48-57 pubmed publisher
    The anesthetic properties of etomidate are largely mediated by gamma-aminobutyric acid type A receptors...
  35. Schaeuble J, Heidegger T, Gerig H, Ulrich B, Schnider T. Comparision of etomidate and propofol for fibreoptic intubation as part of an airway management algorithm:a prospective, randomizes, double-blind study. Eur J Anaesthesiol. 2005;22:762-7 pubmed
    In our algorithm for management of the anticipated difficult airway the induction agent (etomidate) is administered after the tip of the fibreoptic is placed in the trachea but before the tube is advanced over it...
  36. Martin L, Oh G, Orser B. Etomidate targets alpha5 gamma-aminobutyric acid subtype A receptors to regulate synaptic plasticity and memory blockade. Anesthesiology. 2009;111:1025-35 pubmed publisher
    ..acid subtype A receptors that contain the alpha5 subunit (alpha5GABAARs) induce memory-blockade by etomidate and a pharmacologic strategy to reverse this impairment...
  37. Johnson T, Canada T. Etomidate use for Cushing's syndrome caused by an ectopic adrenocorticotropic hormone-producing tumor. Ann Pharmacother. 2007;41:350-3 pubmed
    To report the preparation and use of etomidate in a patient with Cushing's syndrome caused by an ectopic adrenocorticotropic hormone (ACTH)-producing tumor...
  38. Li G, Chiara D, Cohen J, Olsen R. Numerous classes of general anesthetics inhibit etomidate binding to gamma-aminobutyric acid type A (GABAA) receptors. J Biol Chem. 2010;285:8615-20 pubmed publisher
    ..Intravenous anesthetics, including etomidate, propofol, barbiturates, and neuroactive steroids, as well as volatile anesthetics and long-chain alcohols, all ..
  39. Mohammad Z, Afessa B, Finkielman J. The incidence of relative adrenal insufficiency in patients with septic shock after the administration of etomidate. Crit Care. 2006;10:R105 pubmed
    b>Etomidate blocks adrenocortical synthesis when it is administered intravenously as a continuous infusion or a single bolus...
  40. Möller Petrun A, Kamenik M. Bispectral index-guided induction of general anaesthesia in patients undergoing major abdominal surgery using propofol or etomidate: a double-blind, randomized, clinical trial. Br J Anaesth. 2013;110:388-96 pubmed publisher
    In a double-blind, randomized trial, we compared the haemodynamic effects of a bispectral index (BIS)-guided etomidate and propofol infusion for anaesthesia induction in patients undergoing major abdominal surgery...
  41. Greening J, Brain C, Perry L, Mushtaq I, Sales Marques J, Grossman A, et al. Efficient short-term control of hypercortisolaemia by low-dose etomidate in severe paediatric Cushing's disease. Horm Res. 2005;64:140-3 pubmed
    ..Low-dose IV infusion of etomidate, with dose titration according to serum cortisol levels, was administered. Etomidate infusion (3.0 mg/h i.v...
  42. Zuckerbraun N, Pitetti R, Herr S, Roth K, Gaines B, King C. Use of etomidate as an induction agent for rapid sequence intubation in a pediatric emergency department. Acad Emerg Med. 2006;13:602-9 pubmed
    Although etomidate is widely used for rapid sequence intubation (RSI), there is no consensus on the optimal induction agent and no prospective pediatric emergency department (ED) study exists...
  43. Cotton B, Guillamondegui O, Fleming S, Carpenter R, Patel S, Morris J, et al. Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients. Arch Surg. 2008;143:62-7; discussion 67 pubmed publisher
    ..shock on admission (45 [54%] vs 16 [30%]), requirement of vasopressor support (65 [78%] vs 28 [52%]), and etomidate exposure (59 [71%] vs 28 [52%]) were all significantly higher in the nonresponder group (P < .01)...
  44. Husain S, Nirthanan S, Ruesch D, Solt K, Cheng Q, Li G, et al. Synthesis of trifluoromethylaryl diazirine and benzophenone derivatives of etomidate that are potent general anesthetics and effective photolabels for probing sites on ligand-gated ion channels. J Med Chem. 2006;49:4818-25 pubmed
    ..sites of general anesthetics on ligand-gated ion channels, two derivatives of the intravenous general anesthetic etomidate (2-ethyl 1-(phenylethyl)-1H-imidazole-5-carboxylate), in which the 2-ethyl group has been replaced by ..
  45. Bloomfield R, Noble D. Etomidate, pharmacological adrenalectomy and the critically ill: a matter of vital importance. Crit Care. 2006;10:161 pubmed
    b>Etomidate is a potent suppressant of adrenal steroidogenesis,effectively inducing reversible pharmacological adrenalectomy...
  46. Li G, Chiara D, Cohen J, Olsen R. Neurosteroids allosterically modulate binding of the anesthetic etomidate to gamma-aminobutyric acid type A receptors. J Biol Chem. 2009;284:11771-5 pubmed publisher
    Photoaffinity labeling of gamma-aminobutyric acid type A (GABA(A))-receptors (GABA(A)R) with an etomidate analog and mutational analyses of direct activation of GABA(A)R by neurosteroids have each led to the proposal that these ..
  47. Sarkar M, Laussen P, Zurakowski D, Shukla A, Kussman B, Odegard K. Hemodynamic responses to etomidate on induction of anesthesia in pediatric patients. Anesth Analg. 2005;101:645-50, table of contents pubmed
    b>Etomidate is often used for inducing anesthesia in patients who have limited hemodynamic reserve. Using invasive hemodynamic monitoring, we studied the acute effects of a bolus of etomidate during induction of anesthesia in children...
  48. Bloomfield R, Noble D. Etomidate and intensive care physicians. Intensive Care Med. 2005;31:1453; author reply 1454 pubmed
  49. Heyn J, Geiger C, Hinske C, Briegel J, Weis F. Medical suppression of hypercortisolemia in Cushing's syndrome with particular consideration of etomidate. Pituitary. 2012;15:117-25 pubmed publisher
    ..The carboxylated imidazole etomidate is a well known parenteral induction agent for general anaesthesia...
  50. Stewart D, Hotta M, Desai R, Forman S. State-dependent etomidate occupancy of its allosteric agonist sites measured in a cysteine-substituted GABAA receptor. Mol Pharmacol. 2013;83:1200-8 pubmed publisher
    ..b>Etomidate, the allosteric agonist, is an anesthetic that activates or modulates ?1?2?2L GABAA receptors via transmembrane ..
  51. Paris A, Philipp M, Tonner P, Steinfath M, Lohse M, Scholz J, et al. Activation of alpha 2B-adrenoceptors mediates the cardiovascular effects of etomidate. Anesthesiology. 2003;99:889-95 pubmed
    The intravenous anesthetic etomidate exhibits structural similarities to specific alpha2-adrenoceptor agonists of the type such as dexmedetomidine...
  52. Reynolds D, Rosahl T, Cirone J, O Meara G, Haythornthwaite A, Newman R, et al. Sedation and anesthesia mediated by distinct GABA(A) receptor isoforms. J Neurosci. 2003;23:8608-17 pubmed
    The specific mechanisms underlying general anesthesia are primarily unknown. The intravenous general anesthetic etomidate acts by potentiating GABA(A) receptors, with selectivity for beta2 and beta3 subunit-containing receptors ..
  53. Desai R, Ruesch D, Forman S. Gamma-amino butyric acid type A receptor mutations at beta2N265 alter etomidate efficacy while preserving basal and agonist-dependent activity. Anesthesiology. 2009;111:774-84 pubmed publisher
    b>Etomidate acts at gamma-Aminobutyric acid type A (GABAA) receptors containing beta2 or beta3, but not beta1 subunits. Mutations at beta residue 265 (Ser in beta1; Asn in beta2 or beta3) profoundly affect etomidate sensitivity...