Etomidate

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Structural formula
Structural formula of etomidate
General
Non-proprietary name Etomidate
other names
  • (+) - Ethyl 3- (1-phenylethyl) imidazole-4-carboxylate
  • ( R ) -Ethyl 3- (1-phenylethyl) imidazole-4-carboxylate
Molecular formula C 14 H 16 N 2 O 2
External identifiers / databases
CAS number 33125-97-2
EC number 251-385-9
ECHA InfoCard 100,046,700
PubChem 667484
DrugBank DB00292
Wikidata Q418445
Drug information
ATC code

N01 AX07

Drug class

Anesthetics

properties
Molar mass 244.29 g · mol -1
Physical state

firmly

Melting point

67 ° C

solubility

Water: 63.2 mg l −1 (25 ° C)

safety instructions
Please note the exemption from the labeling requirement for drugs, medical devices, cosmetics, food and animal feed
GHS labeling of hazardous substances
07 - Warning 09 - Dangerous for the environment

Caution

H and P phrases H: 302-400
P: 273
Toxicological data

650 mg kg −1 ( LD 50mouseoral )

As far as possible and customary, SI units are used. Unless otherwise noted, the data given apply to standard conditions .

Etomidate is a hypnotic drug introduced in 1973 (= forcing sleep) .

Clinical information

Etomidate acts on GABA receptors and in the reticular formation . It is used to induce anesthesia and is administered parenterally .

Pharmacological properties

The plasma protein binding is approximately 77%. After the injection , the patient usually falls asleep within 10 to 30 seconds (depending on the circulation time and the injection speed ). Muscle twitching ( myoclonus ) can then often be observed, which occur over a period of about a minute. The duration of action is around two to four minutes; this period can be extended through interactions with other drugs (e.g. premedication with benzodiazepines or opiates ). The reduction in effects is based on rapid redistribution and faster biotransformation .

The advantage of etomidate over other narcotics is its neutrality for the circulatory system (and to some extent also for breathing); this also enables it to be used in patients with heart disease. Allergic reactions have also only been described very rarely; etomidate releases histamine in rare cases . Some coronary dilation and lowering of intracranial pressure have been described, but are of no practical importance. The central autonomic nervous system is not inhibited when etomidate is introduced. Continuous infusion is problematic and therefore contraindicated, as it inhibits cortisol synthesis. Even with a single dose, cortisol synthesis can be almost completely eliminated in critically ill patients, which is why the use of etomidate has long been the subject of scientific controversy. The development of carboetomidate , a modified molecule that does not inhibit cortisol synthesis, may offer a way out. Because of its large safety margin , etomidate was often used in everyday clinical practice as an introductory hypnotic to induce anesthesia in patients with limited cardiac reserve, i.e. H. the majority of older patients, especially in comparison to propofol, which has a significantly stronger circulatory depressant effect . A disadvantage, however, is the slightly more frequent occurrence of postoperative nausea and vomiting ( PONV ) compared to propofol if etomidate was used to induce anesthesia, regardless of whether the anesthesia is continued as Propofol- TIVA or with inhalation anesthetics .

Use in executions

On August 24, 2017, etomidate was first used in Florida for an execution by lethal injection (" lethal injection "). Rocuronium and potassium acetate were administered as additional ingredients . The 53-year-old twin murderer Mark Asay died eleven minutes after the injection. The maker of etomidate, the Belgian pharmaceutical company Janssen Pharmaceutica , criticized its use. The company's goal is to “save and improve lives”.

Other Information

Solutions or emulsions with 2 mg / ml are available on the market, so an ampoule with 10 ml contains 20 mg etomidate. The original commercial form Hypnomidate caused severe injection pain in almost all patients . Another form of administration, namely an oil-in-water emulsion , which contains the active ingredient in the emulsion droplets ( Etomidat-Lipuro ), resulted in better tolerability at the injection site.

literature

  • Red List
  • Swiss Medicines Compendium
  • AGES-PharmMed

Trade names

Monopreparations
  • Etomidate Lipuro (D, A, CH)
  • Hypnomidate (D, A)

Web links

  • Entry on etomidate at Vetpharm, accessed on August 5, 2012.

Individual evidence

  1. a b c Entry on etomidate in the ChemIDplus database of the United States National Library of Medicine (NLM) .
  2. a b Etomidate data sheet from Sigma-Aldrich , accessed on March 31, 2011 ( PDF ).
  3. ^ Eduard Burgis: Intensive course in general and special pharmacology, Urban & Fischer, Munich 2008, ISBN 978-3-437-42613-1 .
  4. Jackson WL Jr. Should we use etomidate as an induction agent for endotracheal intubation in patients with septic shock ?: a critical appraisal. Chest. 2005 Mar; 127 (3): 1031-1038, PMID 15764790 .
  5. Cotten JF et al. Carboetomidate: a pyrrole analog of etomidate designed not to suppress adrenocortical function. Anesthesiology. 2010 Mar; 112 (3): 637-644, PMID 20179500 .
  6. Reinhard Larsen: Anesthesia and intensive medicine in cardiac, thoracic and vascular surgery. (1st edition 1986) 5th edition. Springer, Berlin / Heidelberg / New York et al. 1999, ISBN 3-540-65024-5 , pp. 17-20.
  7. Thorsten Denkler: Execution: Florida uses a new poison. In: sueddeutsche.de . August 25, 2017. Retrieved August 25, 2017 .