SCCM Resource Library-Drug Shortage Alert: Etomidate

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Etomidate, a drug used for rapid sequence intubation (RSI) and induction of anesthesia, is currently facing a shortage due to delays in manufacturing, increased demand, and discontinuation of production. This drug acts as a positive allosteric modulator on the gamma-aminobutyric acid (GABA) type A receptor and is also used off-label for procedural sedation and the management of Cushing syndrome.<br /><br />In the event of a shortage, it is recommended to reserve etomidate for specific scenarios such as when alternatives are contraindicated or undesirable, or when surgery is not feasible and the patient cannot take medications orally. Alternative sedatives such as ketamine, propofol, or midazolam can be considered depending on availability.<br /><br />For RSI, alternative agents like ketamine, midazolam, or propofol can be used, and clinicians should be aware of the shortage and familiarize themselves with these alternatives. Procedural sedation can also be managed with alternative agents such as ketamine, midazolam, propofol, or dexmedetomidine infusion. Combination therapy, such as propofol with ketamine or fentanyl, can achieve deep sedation and analgesia.<br /><br />In the management of Cushing syndrome, etomidate is reserved for situations where surgery is not feasible and the patient cannot take medications orally. Alternative options include oral medications like ketoconazole, metyrapone, and mitotane.<br /><br />Etomidate has limited effects on hemodynamic and respiratory functions, making it suitable for rapid, short-term sedation. Concerns about adrenal suppression exist, but single-dose administration has not been shown to increase morbidity or mortality in patients with sepsis.<br /><br />Overall, alternative agents can be used judiciously in appropriate situations to mitigate the impact of the etomidate shortage, although some patients may be affected, particularly those who require hemodynamically stable agents or have severe Cushing syndrome. Institutions are encouraged to develop mitigation strategies and consult with an endocrinologist.

Asset Subtitle

Pharmacology, Crisis Management, 2023, 0:02:00

Meta Tag

Content Type Article

Knowledge Area Pharmacology

Knowledge Area Crisis Management

Membership Level Nonmember

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Resource Allocation

Tag Analgesia and Sedation

Year 2023

Keywords

Etomidate

drug

shortage

alternative sedatives

procedural sedation

Cushing syndrome

oral medications

hemodynamic functions

respiratory functions

mitigation strategies

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