Etomidate Emulsion Dosing for Anesthesia Induction
The recommended induction dose of etomidate emulsion is 0.3 mg/kg IV administered over 30-60 seconds for adults and pediatric patients above 10 years of age. 1
Standard Dosing Protocol
Adults and Children >10 Years
- Standard induction dose: 0.3 mg/kg IV over 30-60 seconds 1
- Dosing range: 0.2-0.6 mg/kg, individualized based on patient factors 1
- Geriatric patients may require reduced doses 1
Pediatric Patients (Conscious Sedation Context)
- Initial dose: 0.2 mg/kg IV over 30-60 seconds 2
- This provides adequate sedation in 60-67% of pediatric patients 2
- Maximum total dose: 0.3 mg/kg to minimize adverse effects 2
- Inadequate data exists for children <10 years for anesthesia induction; such use is not recommended 1
Administration Technique
Inject slowly over 30-60 seconds to minimize side effects, particularly pain on injection and myoclonus 1, 2. The lipid emulsion formulation (Etomidate-Lipuro) significantly reduces injection pain compared to the propylene glycol formulation, with pain occurring in only 14% versus 78% of patients 3.
Pre-treatment Strategies
- Consider fentanyl or droperidol pre-treatment to reduce myoclonus incidence from 37.9% to 12.5-14.3% 4, 2
- Premedication with diazepam also reduces myoclonus frequency 5
Critical Safety Considerations
Adrenal Suppression Management
Etomidate rapidly suppresses cortisol production by inhibiting 11-beta-hydroxylase 4. However, the clinical significance of single-dose administration remains debated:
- For hemodynamically stable patients undergoing brief procedures: Single-dose etomidate can be used with standard monitoring, as clinically significant adrenal insufficiency appears rare despite biochemical suppression 6
- For high-risk patients (known Addison's disease, chronic steroid use, recent pituitary/adrenal surgery): Administer hydrocortisone 100 mg IV bolus immediately before etomidate 7, 6
- Cortisol levels remain within normal laboratory ranges despite biochemical changes in most patients 4
Monitoring Requirements
- Continuous pulse oximetry and cardiac monitoring are mandatory 2
- Regular blood pressure measurements and respiratory assessment 2
- Resuscitation equipment must be immediately available 2
Common Adverse Effects and Incidence
Lipid Emulsion Formulation (Preferred)
- Pain on injection: 14% 3
- Myoclonus: 8-13% (reduced with pre-treatment) 3, 8
- Local skin reaction: 6% 3
- Thrombophlebitis: 3% 3
Respiratory Effects
- Respiratory depression: 16% (usually manageable with supplemental oxygen) 2
- Oxygen desaturation: 5-39% (higher risk at doses ≥0.23 mg/kg) 2
Dosing Pitfalls to Avoid
Do not exceed 0.3 mg/kg in pediatric patients due to increased respiratory depression risk 2. The lipid emulsion formulation is vastly superior to propylene glycol formulation—pain occurs in 25% with propofol versus only 1% with etomidate-lipid emulsion when comparing discomfort profiles 8. Avoid rapid injection (<30 seconds), which increases myoclonus and injection pain 1, 9.
Cardiovascular Stability
Etomidate causes minimal hemodynamic disturbance: mean arterial pressure decreases only 8.5%, heart rate increases 2.8%, and cardiac output decreases 7.6% 10. This makes it superior to other induction agents in hemodynamically unstable patients, though propofol causes more hypotension 8.