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Chemical Compound Review

Etomidate     ethyl3-(1- phenylethyl)imidazole-4...

Synonyms: Amidate, Etomidato, Absele, Ethomidate, Radenarkon, ...
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Disease relevance of Hypnomidate


Psychiatry related information on Hypnomidate


High impact information on Hypnomidate

  • We measured the cortisol and aldosterone responses to ACTH stimulation in five patients receiving etomidate, and we also studied the direct effects of etomidate on enzymes in the rat steroidogenic pathway [1].
  • In rat adrenal cells, etomidate produced a concentration-dependent blockade of the two mitochondrial cytochrome P-450-dependent enzymes, cholesterol-side-chain cleavage enzyme, and 11 beta-hydroxylase, without evident inhibition of the microsomal enzymes in the glucocorticoid pathway [1].
  • As glucuronides are poorly absorbed from the gut, it is proposed that the hepatic biotransformation of nor-ursodeoxycholate to a glucuronide rather than to a glycine amidate in the liver prevented its accumulation in the bile acid pool [10].
  • Etomidate does not suppress PHA-induced growth of normal human lymphocytes [11].
  • Here, chimeric beta1/beta2 subunits coexpressed in Xenopus laevis oocytes with human alpha6 and gamma2 subunits identified a region distal to the extracellular N-terminal domain as a determinant of the selectivity of etomidate [12].

Chemical compound and disease context of Hypnomidate


Biological context of Hypnomidate


Anatomical context of Hypnomidate

  • To identify binding domains in a ligand-gated ion channel for etomidate, an intravenous general anesthetic, we photolabeled nicotinic acetylcholine receptor (nAChR)-rich membranes from Torpedo electric organ with a photoactivatable analog, [(3)H]azietomidate [22].
  • We report the emergency and prolonged use of etomidate to control circulating cortisol levels in a patient with Cushing's syndrome secondary to ectopic ACTH production from a pancreatic islet cell tumor [23].
  • We show that bovine adrenal chromaffin cells were excited by etomidate at clinically relevant concentrations [24].
  • Modulation of [3H]muscimol binding by picrotoxin, pentobarbitone, and etomidate was investigated in rat cerebellar and cerebral cortical membranes [25].
  • In 12 dogs we therefore studied (six control and six endotoxin treated, 1.5 mg X kg-1) under etomidate (4 mg X kg-1 X h-1) anaesthesia muscle blood flow (radioactive microspheres) in fore limb, thorax, diaphragm and hind limb (five different muscles) and skin blood flow before (t = 0) and 90 and 120 min after endotoxin [26].

Associations of Hypnomidate with other chemical compounds


Gene context of Hypnomidate

  • In alpha2B-receptor-expressing HEK293 cells, etomidate rapidly increased phosphorylation of the extracellular signal-related kinases ERK1/2 [31].
  • RESULTS: In vivo, loss and recovery of the righting reflex required similar times after intraperitoneal injection of etomidate in wild-type and in alpha2A-receptor-deficient mice, indicating that the hypnotic effect of etomidate in mice does not require the alpha2A-receptor subtype [31].
  • CONCLUSIONS: The GABAA receptor beta 2 subunit mediates a significant proportion of the hypothermic effects of etomidate [8].
  • During the infusion of etomidate, a significant increase in the peripheral concentration of ACTH occurred, while plasma cortisol concentrations decreased [32].
  • Cytochrome P-450 binding spectra displayed type II binding with a UV light absorption maximum (lambda max) at a wavelength of 424 nm in the presence of etomidate [33].

Analytical, diagnostic and therapeutic context of Hypnomidate


  1. Inhibition of adrenal steroidogenesis by the anesthetic etomidate. Wagner, R.L., White, P.F., Kan, P.B., Rosenthal, M.H., Feldman, D. N. Engl. J. Med. (1984) [Pubmed]
  2. Effect of etomidate on hypercortisolism due to ectopic ACTH production. Gärtner, R., Albrecht, M., Müller, O.A. Lancet (1986) [Pubmed]
  3. Expression and precursor processing of neuropeptide Y in human and murine neuroblastoma and pheochromocytoma cell lines. O'Hare, M.M., Schwartz, T.W. Cancer Res. (1989) [Pubmed]
  4. Conscious sedation with combined hypnotic agents for implantation of implantable cardioverter-defibrillators. Pacifico, A., Cedillo-Salazar, F.R., Nasir, N., Doyle, T.K., Henry, P.D. J. Am. Coll. Cardiol. (1997) [Pubmed]
  5. Adrenal insufficiency in meningococcal sepsis: bioavailable cortisol levels and impact of interleukin-6 levels and intubation with etomidate on adrenal function and mortality. den Brinker, M., Joosten, K.F., Liem, O., de Jong, F.H., Hop, W.C., Hazelzet, J.A., van Dijk, M., Hokken-Koelega, A.C. J. Clin. Endocrinol. Metab. (2005) [Pubmed]
  6. Etomidate-induced convulsion prior to electroconvulsive therapy. Nicoll, K., Callender, J. The British journal of psychiatry : the journal of mental science. (2000) [Pubmed]
  7. Opposing actions of etomidate on cortical theta oscillations are mediated by different gamma-aminobutyric acid type A receptor subtypes. Drexler, B., Roether, C.L., Jurd, R., Rudolph, U., Antkowiak, B. Anesthesiology (2005) [Pubmed]
  8. Gamma-aminobutyric acid type A receptor beta 2 subunit mediates the hypothermic effect of etomidate in mice. Cirone, J., Rosahl, T.W., Reynolds, D.S., Newman, R.J., O'Meara, G.F., Hutson, P.H., Wafford, K.A. Anesthesiology (2004) [Pubmed]
  9. Ketamine appears associated with better word recall than etomidate after a course of 6 electroconvulsive therapies. McDaniel, W.W., Sahota, A.K., Vyas, B.V., Laguerta, N., Hategan, L., Oswald, J. The journal of ECT. (2006) [Pubmed]
  10. Differing effects of nor-ursodeoxycholic or ursodeoxycholic acid on hepatic histology and bile acid metabolism in the rabbit. Cohen, B.I., Hofmann, A.F., Mosbach, E.H., Stenger, R.J., Rothschild, M.A., Hagey, L.R., Yoon, Y.B. Gastroenterology (1986) [Pubmed]
  11. Etomidate does not suppress PHA-induced growth of normal human lymphocytes. Spiers, E.M., MacConnachie, A., Beck, J.S. Lancet (1983) [Pubmed]
  12. The interaction of the general anesthetic etomidate with the gamma-aminobutyric acid type A receptor is influenced by a single amino acid. Belelli, D., Lambert, J.J., Peters, J.A., Wafford, K., Whiting, P.J. Proc. Natl. Acad. Sci. U.S.A. (1997) [Pubmed]
  13. The effect of etomidate on adrenocortical function in dogs before and during hemorrhagic shock. Fraser, R., Watt, I., Gray, C.E., Ledingham, I.M., Lever, A.F. Endocrinology (1984) [Pubmed]
  14. Etomidate-anaesthesia, with and without fentanyl, compared with urethane-anaesthesia in the rat. De Wildt, D.J., Hillen, F.C., Rauws, A.G., Sangster, B. Br. J. Pharmacol. (1983) [Pubmed]
  15. Inhibition of glucose transport and direct interactions with type 1 facilitative glucose transporter (GLUT-1) by etomidate, ketamine, and propofol: a comparison with barbiturates. Stephenson, K.N., Croxen, R.L., El-Barbary, A., Fenstermacher, J.D., Haspel, H.C. Biochem. Pharmacol. (2000) [Pubmed]
  16. Etomidate does not alter recovery after anoxia of evoked population spikes recorded from the CA1 region of rat hippocampal slices. Amadeu, M.E., Abramowicz, A.E., Chambers, G., Cottrell, J.E., Kass, I.S. Anesthesiology (1998) [Pubmed]
  17. Absolute and relative adrenal insufficiency in children with septic shock. Pizarro, C.F., Troster, E.J., Damiani, D., Carcillo, J.A. Crit. Care Med. (2005) [Pubmed]
  18. Metabolic activation of the potent mutagen, 2-naphthohydroxamic acid, in Salmonella typhimurium TA98. Lee, M.S., Isobe, M. Cancer Res. (1990) [Pubmed]
  19. Gating allosterism at a single class of etomidate sites on alpha1beta2gamma2L GABA A receptors accounts for both direct activation and agonist modulation. Rüsch, D., Zhong, H., Forman, S.A. J. Biol. Chem. (2004) [Pubmed]
  20. Inhibition by etomidate of steroidogenesis in isolated bovine adrenal cells. Kenyon, C.J., Young, J., Gray, C.E., Fraser, R. J. Clin. Endocrinol. Metab. (1984) [Pubmed]
  21. Plasma protein binding of etomidate in patients with renal failure or hepatic cirrhosis. Carlos, R., Calvo, R., Erill, S. Clinical pharmacokinetics. (1979) [Pubmed]
  22. Identification of binding sites in the nicotinic acetylcholine receptor for [3H]azietomidate, a photoactivatable general anesthetic. Ziebell, M.R., Nirthanan, S., Husain, S.S., Miller, K.W., Cohen, J.B. J. Biol. Chem. (2004) [Pubmed]
  23. Emergency and prolonged use of intravenous etomidate to control hypercortisolemia in a patient with Cushing's syndrome and peritonitis. Drake, W.M., Perry, L.A., Hinds, C.J., Lowe, D.G., Reznek, R.H., Besser, G.M. J. Clin. Endocrinol. Metab. (1998) [Pubmed]
  24. Etomidate elevates intracellular calcium levels and promotes catecholamine secretion in bovine chromaffin cells. Xie, Z., Currie, K.P., Fox, A.P. J. Physiol. (Lond.) (2004) [Pubmed]
  25. Modulation of [3H]muscimol binding in rat cerebellar and cerebral cortical membranes by picrotoxin, pentobarbitone, and etomidate. Quast, U., Brenner, O. J. Neurochem. (1983) [Pubmed]
  26. Skeletal muscle perfusion and metabolism during canine endotoxin shock. van Lambalgen, A.A., Bronsveld, W., van den Bos, G.C., Thijs, L.G., Kester, A.D. Cardiovasc. Res. (1985) [Pubmed]
  27. Facilitatory action of etomidate and pentobarbital on recurrent inhibition in rat hippocampal pyramidal neurons. Proctor, W.R., Mynlieff, M., Dunwiddie, T.V. J. Neurosci. (1986) [Pubmed]
  28. A single glycine residue at the entrance to the first membrane-spanning domain of the gamma-aminobutyric acid type A receptor beta(2) subunit affects allosteric sensitivity to GABA and anesthetics. Carlson, B.X., Engblom, A.C., Kristiansen, U., Schousboe, A., Olsen, R.W. Mol. Pharmacol. (2000) [Pubmed]
  29. Differential subunit dependence of the actions of the general anesthetics alphaxalone and etomidate at gamma-aminobutyric acid type A receptors expressed in Xenopus laevis oocytes. Sanna, E., Murgia, A., Casula, A., Biggio, G. Mol. Pharmacol. (1997) [Pubmed]
  30. Anticonvulsants but not general anesthetics have differential blocking effects on different T-type current variants. Todorovic, S.M., Perez-Reyes, E., Lingle, C.J. Mol. Pharmacol. (2000) [Pubmed]
  31. Activation of alpha 2B-adrenoceptors mediates the cardiovascular effects of etomidate. Paris, A., Philipp, M., Tonner, P.H., Steinfath, M., Lohse, M., Scholz, J., Hein, L. Anesthesiology (2003) [Pubmed]
  32. Etomidate suppresses adrenocortical function by inhibition of 11 beta-hydroxylation. de Jong, F.H., Mallios, C., Jansen, C., Scheck, P.A., Lamberts, S.W. J. Clin. Endocrinol. Metab. (1984) [Pubmed]
  33. Effect of etomidate on hepatic drug metabolism in humans. Atiba, J.O., Horai, Y., White, P.F., Trevor, A.J., Blaschke, T.F., Sung, M.L. Anesthesiology (1988) [Pubmed]
  34. Etomidate in the intensive care unit. Miranda, D.R., Stoutenbeek, C.P. Lancet (1983) [Pubmed]
  35. Development and validation of a robust capillary electrophoresis method for impurity profiling of etomidate including the determination of chiral purity using a dual cyclodextrin system. Hammitzsch, M., Rao, R.N., Scriba, G.K. Electrophoresis (2006) [Pubmed]
  36. Increased sensitivity to etomidate in the elderly: initial distribution versus altered brain response. Arden, J.R., Holley, F.O., Stanski, D.R. Anesthesiology (1986) [Pubmed]
  37. Comparison of the effects of etomidate, propofol, and thiopental on respiratory resistance after tracheal intubation. Eames, W.O., Rooke, G.A., Wu, R.S., Bishop, M.J. Anesthesiology (1996) [Pubmed]
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