Etomidate Pediatric Dose — Procedural Sedation & RSI
Etomidate is a non-barbiturate imidazole sedative-hypnotic that exerts its effect through positive allosteric modulation of GABA-A receptors, producing rapid unconsciousness with minimal cardiovascular depression. In pediatric practice, it is primarily used as an induction agent during rapid sequence intubation (RSI) when hemodynamic stability is a priority. Its ultra-short duration of action and favorable cardiorespiratory profile make it a valuable option in critically ill children.
Pediatric Dosing
- Induction for intubation (RSI): 0.5 mg/kg IV, administered as a single dose
Administer the full dose as a single intravenous bolus immediately prior to intubation. No repeat dosing is described in this indication; consult institutional protocol for additional sedation requirements post-intubation.
Worked example: For a 20 kg child: 20 × 0.5 mg/kg = 10 mg total IV once. For a 10 kg child: 10 × 0.5 mg/kg = 5 mg total IV once.
Indications and Clinical Context
Etomidate is indicated as an induction agent for RSI in pediatric patients requiring emergent or urgent endotracheal intubation. Its primary advantage lies in its hemodynamic neutrality — unlike propofol or ketamine in certain contexts, etomidate produces minimal changes in heart rate and blood pressure, making it especially useful in patients with cardiovascular compromise, trauma, or elevated intracranial pressure. It is commonly employed in pediatric emergency department and PICU settings in alignment with institutional RSI protocols.
Clinicians should be aware that etomidate causes transient adrenocortical suppression via inhibition of 11-β-hydroxylase, even after a single dose. While a single induction dose is generally accepted in emergency RSI, this consideration is particularly relevant in patients with suspected or known adrenal insufficiency or those with septic shock, where stress-response cortisol production is critical.
Administration and Monitoring
Etomidate is administered exclusively via the intravenous (IV) route as a rapid bolus. Onset of action is approximately 30–60 seconds, with a clinical duration of 3–5 minutes. It should be given after pre-oxygenation and concurrent with a neuromuscular blocking agent during RSI. Monitor for the following:
- Myoclonus: Transient involuntary muscle movements occur in a significant proportion of patients; pre-treatment with a defasciculating dose or benzodiazepine may attenuate this.
- Adrenocortical suppression: Even a single dose transiently suppresses cortisol synthesis; use with caution in septic shock — consult institutional protocol.
- Apnea: Brief apnea may follow induction; ensure airway equipment and personnel are immediately available.
- Pain on injection: May occur; use a large, free-flowing IV when possible.
No maximum single dose is specified in the source description; consult institutional protocol for weight-based dose caps in larger pediatric patients.
Disclaimer: This article is an educational reference summarizing standard pediatric dosing values. It is not a substitute for clinical judgment. Always verify doses against institutional protocols, the current edition of authoritative references (e.g., Lexicomp, Harriet Lane Handbook, PALS guidelines), the patient’s accurate weight, and any patient-specific factors (renal/hepatic function, allergies, comedications) before administration.