A primary advantage of etomidate in patients with hemodynamic instability, and what is a major risk?

• A. Maintains stable heart rate and blood pressure; risk includes suppression of adrenal cortisol synthesis.
• B. Causes tachycardia and hypertension; risk includes adrenal suppression.
• C. Causes significant vasodilation; risk of renal failure.
• D. Increases intracranial pressure; risk of sedation.

Answer: (A)

Etomidate is favored when a patient’s circulation is fragile because it tends to preserve cardiovascular stability during induction, causing little change in heart rate, blood pressure, or systemic vascular resistance. This makes it the best choice for someone with hemodynamic instability since you’re less likely to provoke a dangerous drop in perfusion during intubation.

The major risk linked to etomidate is adrenal suppression. It inhibits an adrenal enzyme (11β-hydroxylase), which can blunt cortisol production in response to stress. This effect can be transient after a single dose but becomes more clinically important with repeated doses or prolonged infusion, as the reduced cortisol can impair the body’s ability to handle stress from surgery or critical illness and may worsen hemodynamic instability or delay recovery. Additionally, etomidate tends to preserve or even reduce intracranial pressure rather than increase it, and it does not typically cause tachycardia or significant vasodilation, which is why those other scenarios aren’t the primary concern.