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INTRODUCTION

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HIGH ALERT

etomidate (e-tom-i-date)

Amidate

Classification

Therapeutic: general anesthetics

Pharmacologic: imidazoles

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Indications
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Induction of general anesthesia. Supplemental anesthesia with other agents (nitrous oxide) for short procedures.

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Action
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Hypnotic CNS depressant without analgesic activity. Therapeutic Effects: Induction/supplementation of general anesthesia.

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Adverse Reactions/Side Effects
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CV: arrhythmias, hypertension, hypotension. Resp: APNEA, LARYNGOSPASM, hyperventilation, hypoventilation. GI: postoperative nausea/vomiting. Local: transient injection site pain. MS: transient skeletal muscle movements.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor postoperative respiration, and notify physician or nursing staff immediately if patient exhibits any interruption in respiratory rate (apnea) or wheezing, coughing, tightness in chest, or shortness of breath that might indicate laryngospasm. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation, respiratory rate, and respiratory function.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

  • Be alert for abnormal or involuntary muscle movements. Document the location, frequency, and severity of these movements, and report these findings to the physician or nursing staff.

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Interventions
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  • Implement breathing activities and other therapeutic exercises to encourage ventilation and help overcome any residual effects of the anesthetic.

  • Because of the risk of arrhythmias and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • Guard against falls and trauma (hip fractures, head injury) during the immediate postoperative period. Implement fall prevention strategies (See Appendix E), especially if patient exhibits sedation, dizziness, or blurred vision.

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Patient/Client-Related Instruction
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  • Instruct patient to report other troublesome postoperative effects such as severe or prolonged injection site pain or GI problems (nausea, vomiting).

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Pharmacokinetics
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Absorption: IV administration results in complete bioavailability.

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Distribution: Distributes rapidly from blood into CNS, followed by rapid clearance and tissue distribution.

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Metabolism and Excretion: Mostly metabolized by the liver. 75% excreted in urine as inactive metabolite; 10–13% excreted in bile and feces.

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Half-life: 1.25–5 hr.

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TIME/ACTION PROFILE (hypnosis)

ROUTE ONSET PEAK DURATION
IV within 1 min unknown 3–5 min

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Prolonged ...

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