Etomidate is a short-acting intravenous anesthetic used as a sedative-hypnotic agent. Critically ill patients exposed to etomidate may experience adrenal insufficiency.
Etomidate suppresses adrenal gland function with impaired steroidogenesis. This can be important for a person with impaired adrenal function from other cause.
Features of adrenocortical insufficiency:
(1) hypotension refractory to standard vasopressors
(2) lethargy
(3) hemodynamic instability
The main use of etomidate has been in rapid-sequence intubation.
The issue of etomidate-induced adrenal insufficiency is of concern in critically-ill patients with sepsis or extensive burns.
The main adverse effect appears to be a transient hypotension. There are reports of adrenal insufficiency in patients receiving a single dose of etomidate but causality can be difficult to prove.
The message appears to be:
(1) consider an alternative drug in a high-risk patient.
(2) monitor the patient's blood pressure during the 24 hours after administration
(3) be prepared for adrenal insufficiency
