7.

General Anaesthesia, Intravenous agents – Droperidol, Etomidate

Droperidol

An antidopaminergic drug used as an antiemetic and antipsychotic. Droperidol is also often used

for neuroleptanalgesic anesthesia and sedation in intensive-care treatment.

It has a central antiemetic action and effectively prevents postoperative nausea and vomiting in adults
using doses as low as 0.625 mg. It has also been used as an antipsychotic in doses ranging from 5 to
10 mg given as an intramuscular injection, generally in cases of severe agitation in a psychotic patient
who is refusing oral medication.

Side Effects

>10%

 Restlessness
 Anxiety
 Extrapyramidal Symptoms
 Dystonic reactions
 Pseudoparkinsonian signs and symptoms
 Tardive dyskinesia
 Seizure
 Altered central temperature regulation
 Sedation
 Drowsiness
 Prolonged QT interval (dose dependent)
 Swelling of breasts
 Weight gain
 Constipation

1-10%

 Hallucinations
 Persistent tardive dyskinesia
 Akathisia
 Orthostatic hypotension
 Tachycardia
 ECG: abnormal T waves
 Hypertension
 Nausea
 Vomiting
 Dysuria

Frequency Not Defined

Serious, potentially fatal cardiac effects: prolonged QT interval, torsades de pointes, cardiac arrest,
ventricular tachycardia

Contraindications

 amiodarone
 astemizole
 cisapride
 disopyramide
 ibutilide
 indapamide
 pentamidine
 pimozide
 procainamide
 quinidine
 sotalol
 terfenadine

Dosage

Adult

Injectable solution

 2.5mg/mL

Antiemetic

 Initial: No more than 2.5 mg IV/IM; additional doses of 1.25 mg may be given if benefit
outweighs potential risk

Paediatric

Injectable solution

 2.5mg/mL

Antiemetic

 2-12 years: 0.03-0.07 mg/kg IV/IM over 2-5 minutes q4-6hr PRN 
 Not to exceed 0.1 mg/kg IV/IM, additional dose (no more than 2.5 mg) may be given ONLY IF
benefit outweighs potential risk

Geriatric

Antiemetic

 Initial: No more than 2.5 mg IV/IM; additional doses of 1.25 mg may be given if benefit
outweighs potential risk

Etomidate
Etomidate  is a short-acting intravenous anaesthetic agent used for the induction of general
anaesthesia and sedation for short procedures such as reduction of dislocated joints, tracheal
intubation, and cardioversion. It was introduced as an intravenous agent in 1972 in Europe and in 1983
in the United States.

Medical uses

In emergency settings, etomidate is one of the most frequently used sedative hypnotic agents. It is used
for conscious sedation and as a part of a rapid sequence induction to induce anaesthesia. It is used as an
anaesthetic agent since it has a rapid onset of action and a safe cardiovascular risk profile, and therefore
is less likely to cause a significant drop in blood pressure than other induction agents. In addition,
etomidate is often used because of its easy dosing profile, limited suppression of ventilation, lack of
histamine liberation and protection from myocardial and cerebral ischemia. Thus, etomidate is a good
induction agent for people who are hemodynamically unstable.

Etomidate also has interesting characteristics for people with traumatic brain injury because it is one of
the only anesthetic agents able to decrease intracranial pressure and maintain a normal arterial
pressure.

In those with sepsis, one dose of the medication does not appear to affect the risk of death.

Side effects

 Using a continuous etomidate infusion for sedation of critically ill trauma patients in intensive
care units has been associated with increased mortality due to adrenal suppression.
 Continuous intravenous administration of etomidate leads to adrenocortical dysfunction. The
mortality of patients exposed to a continuous infusion of etomidate for more than 5 days
increased from 25% to 44%, mainly due to infectious causes such as pneumonia.
 In a retrospective review of almost 32,000 people, etomidate, when used for the induction of
anaesthesia, was associated 2.5-fold increase in the risk of dying compared with those given
propofol. People given etomidate also had significantly greater odds of having cardiovascular
morbidity and significantly longer hospital stay. 
 Injection site pain
 eye movement
 skeletal muscle movements

Dosage

The dose for induction of anesthesia in adult patients and in pediatric patients above the age of ten
years will vary between 0.2 and 0.6 mg/kg of body weight, and it must be individualized in each case.
The usual dose for induction in these patients is 0.3 mg/kg, injected over a period of 30 to 60 seconds. in
patients below the age of ten years use is not recommended. Geriatric patients may require reduced
doses of Etomidate.