Abstract

Etomidate, an induction agent, was synthesized in 1964 and introduced in clinical practice in 1972 in Europe and 1983 in the United States [1]. However, the drug was reformulated using lipid emulsion and reintroduced in 2007 in India. Etomidate is a carboxylated imidazole, confers the advantage of better hemodynamic stability, minimal respiratory depression, cerebral protective effects, and less injection pain compared to propofol, when used for the induction of general anesthesia [2]. Its lack of effect on the sympathetic nervous system, baroreceptor reflex regulatory system, and its property of increased coronary perfusion even on patients with moderate cardiac dysfunction makes it an induction agent of choice in cardiac disease patients [3-5]. Despite the benefits, there are two major complications associated with etomidate use. The first one is pain on injection, which can be prevented to some extent with a new lipophilic combination. The second most certain and undesirable side effect of etomidate is myoclonus, which is still one of the difficulties of its use among anesthesiologists and the incidence has been reported as much as 50%–80% after induction [6]. The consequences of this side effect can be serious in nonfasted emergency patients, patients with open eye injuries, or patients with limited cardiovascular reserves

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