Introduction and maintenance of general anesthesia. Also as anesthesia under local anesthesia. The simultaneous use of inhalation anesthesia is not necessary; if it is used, the inhaled medicine may be given in a very small dose (general intravenous anesthesia). The drug is indicated for short diagnostic procedures or procedures carried out in outpatient settings, in which a quick awakening of the patient is necessary. The effect of etomidate in the recommended doses on hemodynamic parameters is very small, and therefore it is particularly indicated in cardiac surgery and in patients with heart disease.
Composition:
1 ampoule contains 20 mg of etomidate.
Action:
A short-acting hypnotic for intravenous use under general anesthesia; without analgesia. After a single intravenous dose, it quickly induces a 5-minute sleep, followed by a quick wake-up call. It also acts as an anticonvulsant and protects the brain tissue against cell damage caused by hypoxia. It minimally affects the cardiovascular system, does not release histamine, does not affect the liver function. It causes 6-8-hour suppression of the adrenal cortex. In about 76.5% it is bound to plasma proteins. It is metabolized in the liver. After 24 h, 75% of the dose is excreted in the urine, mainly in the form of metabolites. Final T0,5 is 3-5 hours. In children (aged 7-13 years), the volume of distribution (adjusted for body weight) was 2.4-fold higher than in adults, and about 58% greater clearance than in adults, which indicates the need for in children, doses of the drug higher than in adult patients. In the elderly (> 65 years), the clearance of etomidate is reduced compared to younger people; the initial blood levels are higher in the elderly due to the lower initial volume of distribution, therefore a reduction in the dose may be necessary in this group of patients.
Contraindications:
Hypersensitivity to the active substance or to any of the excipients.
Precautions:
Without additional risk, etomidate may be used in patients with epilepsy, glaucoma, porphyria as well as in patients with a history of malignant hyperthermia. Due to the small and transient decrease in blood pressure caused by the drug, caution should be exercised in weakened patients in whom hypotension may be dangerous (prior to introducing anesthesia, a vein should be available to ensure adequate circulating blood volume, as far as possible should be avoided) other medicines used for the introduction of anesthesia, place the patient on the supine, inject slowly, eg at a rate of 10 ml / min). Use with caution in elderly patients. Due to the transient suppression of the adrenal cortex caused by etomidate, in patients in severe stress, especially with adrenal cortex dysfunction, supplementation with cortisol should be considered; in such situations, stimulation of the adrenal glands with ACTH does not give the desired results. The administration of continuous or repeated infusion of etomidate should be avoided, as this method of administration may result in long-term suppression of endogenous cortisol and aldosterone. Premedication with a small dose of fentanyl with a droperidol or diazepam reduces the risk of spontaneous muscle movements. Premedication with opioids reduces the risk of myoclonic seizures and pain at the injection site.
Pregnancy and lactation:
Etomidate can be used during pregnancy only if the potential benefits outweigh the risks to the fetus. The assessment of newborn infants whose mothers received anomomidate on the Apgar scale was comparable to the assessment of newborns whose mothers received other sleeping pills. In newborns whose mothers received etomidate, a transient, 6-hour reduction in cortisol, which usually remains within normal limits, may occur. Use with caution when breast-feeding.
Side effects:
Observed in clinical trials in ≥1% of patients: dyskinesia, myoclonic convulsions, venous pain, hypotension, apnea, hyperventilation, larynx, vomiting, nausea, rash. Clinically observed in <1% of patients: hypertension, involuntary muscle contractions, nystagmus, bradycardia, additional spasms, extra ventricular cramps, hypertension, phlebitis, cough, hiccups, hypoventilation, salivation, erythema, muscle stiffness, pain in place injection, complications of anesthesia, delayed regaining consciousness after anesthesia, insufficient analgesia, nausea during treatments. In addition, hypersensitivity reactions (including anaphylactic shock, anaphylactoid and anaphylactoid reactions), adrenal insufficiency, convulsions (including primary generalized seizures), cardiac arrest, total atrioventricular block, shock, thrombophlebitis (deep and superficial), respiratory depression and bronchospasm (including death), Stevens-Johnson syndrome, urticaria, trismus.
Dosage:
Intravenously. Individually depending on the patient's response and clinical activity. Adults: 0.3 mg / kg; children <15 years: the dose should be increased to achieve the same depth and time of sleep as in adults, sometimes a supplementary dose of about 30% of the usual dose for adults is required; Elderly patients: a single dose of 0.15-0.2 mg / kg should be given, which should then be adjusted individually depending on the patient's response. In patients with liver cirrhosis and those who have already received a neuroleptic, an opioid or sedative, the dose of etomidate should be reduced. Sleep can be prolonged by administering additional doses of etomidate. Do not use more than 3 amps. (30 ml). Etomidate does not have analgesia and therefore during the surgery should be given the right analgesic, for example 1-2 ml of fentanyl intravenously for 1-2 min before administration of etomidate.
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