GasGasGas - The FRCA Primary Exam Podcast GasGasGas - Etomidate
Sep 12, 2025
Delve into the fascinating world of Etomidate, from its GABA-A activity to its adverse effects like myoclonus. Explore dosing nuances and its hemodynamic stability in sedation. Learn about the drug's impact on adrenal suppression and enzyme inhibition, and consider the clinical applications alongside toxicity. The discussion also covers intriguing historical findings in ICU settings and research on Etomidate analogues. With insights on steroidogenesis and bioavailability, this discussion is packed with essential details for aspiring anesthetists!
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Drug Chemistry And Formulation Matter
- Etomidate is a carboxylated imidazole ester that exists as an R-enantiomer clinically and can appear as an acidic propylene glycol solution or a neutral lipid emulsion.
- It is highly lipophilic and ~99% unionised at physiological pH, explaining rapid CNS penetration and onset.
Personal Use And First Impressions
- Gas Lurks recalls seeing etomidate used infrequently and perceiving it as slow to act in his experience.
- He notes clinical formulations shifted from propylene glycol solution to a milky lipid emulsion.
Choose Etomidate For Hemodynamic Stability
- Use etomidate when cardiovascular stability is a priority because it causes minimal change in cardiac oxygen supply-demand and only slight drops in SVR and CO.
- Prefer it for unstable coronary disease patients where maintaining haemodynamics matters during induction.
