lUNLICENSED USEHypnomidate®licensed for use in
children (age range not specified by manufacturer).
Etomidate-Lipuro®not licensed for children under
6 months except for imperative indications during
inpatient treatment. Doses inBNF for Childrenmay differ
from those in the product literature.
IMPORTANT SAFETY INFORMATION
Etomidate should only be administered by, or under the
direct supervision of, personnel experienced in its use,
with adequate training in anaesthesia and airway
management, and when resuscitation equipment is
available.lCAUTIONSAcute circulatory failure (shock).adrenal
insufficiency.Avoid in Acute porphyrias p. 603.
cardiovascular disease.fixed cardiac output.
hypovolaemia
CAUTIONS, FURTHER INFORMATION
▶Adrenal insufficiencyEtomidate suppresses adrenocortical
function, particularly during continuous administration,
and it should not be used for maintenance of anaesthesia.
It should be used with caution in patients with underlying
adrenal insufficiency, for example, those with sepsis.
lINTERACTIONS→Appendix 1 : etomidate
lSIDE-EFFECTS
▶Common or very commonApnoea.hypotension.
movement disorders.nausea.respiratory disorders.skin
reactions.vascular disorders.vomiting
▶UncommonArrhythmias.cough.hiccups.hypersalivation
.hypertension.muscle rigidity.neuromuscular
dysfunction.nystagmus
▶Frequency not knownAdrenal insufficiency.
atrioventricular block.cardiac arrest.embolism and
thrombosis.seizures.shock.Stevens-Johnson syndrome.
trismus
SIDE-EFFECTS, FURTHER INFORMATION
Pain on injectionCan be reduced by injecting into a
larger vein or by giving an opioid analgesic just before
induction.
Extraneous muscle movementsExtraneous muscle
movements can be minimised by an opioid analgesic or a
short-acting benzodiazepine given just before induction.
lPREGNANCYMay depress neonatal respiration if used
during delivery.
lBREAST FEEDINGBreast-feeding can be resumed as soon
as mother has recovered sufficiently from anaesthesia.
lHEPATIC IMPAIRMENT
Dose adjustmentsReduce dose in liver cirrhosis.
lDIRECTIONS FOR ADMINISTRATIONTo be administered
over 30 – 60 seconds ( 60 seconds in patients in whom
hypotension might be hazardous).
lPATIENT AND CARER ADVICE
Driving and skilled tasksPatients given sedatives and
analgesics during minor outpatient procedures should be
very carefully warned about the risk of driving or
undertaking skilled tasks afterwards. For a short general
anaesthetic the risk extends toat least 24 hoursafter
administration. Responsible persons should be available to
take patients home. The dangers of takingalcoholshould
also be emphasised.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
EXCIPIENTS:May contain Propylene glycol
▶Hypnomidate(Piramal Critical Care Ltd)
Etomidate 2 mg per 1 mlHypnomidate 20 mg/ 10 ml solution for
injection ampoules| 5 ampouleP£ 6. 90
Emulsion for injection
▶Etomidate-Lipuro(B.Braun Medical Ltd)
Etomidate 2 mg per 1 mlEtomidate-Lipuro 20 mg/ 10 ml emulsion for
injection ampoules| 10 ampouleP£ 16. 09Propofol
lINDICATIONS AND DOSE
Induction of anaesthesia using 0. 5 %or 1 % injection
▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
INFUSION
▶Child 1 month–16 years:Usual dose 2. 5 – 4 mg/kg, dose
adjusted according to age, body-weight and response
▶Child 17 years:Usual dose 1. 5 – 2. 5 mg/kg, to be
administered at a rate of 20 – 40 mg every 10 seconds
until response
Induction of anaesthesia using 2 % injection
▶BY INTRAVENOUS INFUSION
▶Child 3–16 years:Usual dose 2. 5 – 4 mg/kg, dose adjusted
according to age, body-weight and response
▶Child 17 years:Usual dose 1. 5 – 2. 5 mg/kg, to be
administered at a rate of 20 – 40 mg every 10 seconds
until response
Maintenance of anaesthesia using 1 % injection
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Child 1 month–16 years:Usual dose 9 – 15 mg/kg/hour,
dose adjusted according to age, body-weight and
response
▶Child 17 years:Usual dose 4 – 12 mg/kg/hour, adjusted
according to response
Maintenance of anaesthesia using 2 % injection
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Child 3–16 years:Usual dose 9 – 15 mg/kg/hour, dose
adjusted according to age, body-weight and response
▶Child 17 years:Usual dose 4 – 12 mg/kg/hour, adjusted
according to response
Sedation of ventilated patients in intensive care using 1 %
or 2 % injection
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Child 16–17 years:Usual dose 0. 3 – 4 mg/kg/hour,
adjusted according to response
Induction of sedation for surgical and diagnostic
procedures using 0. 5 %or 1 % injection
▶BY SLOW INTRAVENOUS INJECTION
▶Child 1 month–16 years:Initially 1 – 2 mg/kg, dose and
rate of administration adjusted according to desired
level of sedation and response
▶Child 17 years:Initially 0. 5 – 1 mg/kg, to be administered
over 1 – 5 minutes, dose and rate of administration
adjusted according to desired level of sedation and
response
Maintenance of sedation for surgical and diagnostic
procedures using 0. 5 % injection
▶INITIALLY BY INTRAVENOUS INFUSION
▶Child 17 years:Initially 1. 5 – 4. 5 mg/kg/hour, dose and
rate of administration adjusted according to desired
level of sedation and response, followed by (by slow
intravenous injection) 10 – 20 mg, (if rapid increase in
sedation required)
Maintenance of sedation for surgical and diagnostic
procedures using 1 % injection
▶INITIALLY BY INTRAVENOUS INFUSION
▶Child 1 month–16 years:Usual dose 1. 5 – 9 mg/kg/hour,
dose and rate of administration adjusted according to
desired level of sedation and response, followed by (by
slow intravenous injection) up to 1 mg/kg, (if rapid
increase in sedation required)
▶Child 17 years:Initially 1. 5 – 4. 5 mg/kg/hour, dose and
rate of administration adjusted according to desired
level of sedation and response, followed by continued→BNFC 2018 – 2019 General anaesthesia 805
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