Etomidate Analogs: State of Development

ABSTRACT: As an anesthetic agent, etomidate provides profound hemodynamic stability, superior to propofol even when it is dose reduced. However, its use has been curtailed due to concerns regarding adrenal cortical suppression demonstrated clinically in the setting of prolonged infusion for sedation in the intensive care unit. In addition, etomidate reproducibly results in significant myoclonus when employed in the absence of other pharmacology. Recently, utilizing both pharmacokinetic and pharmacodynamic considerations, a number of etomidate analogs have been developed that retain the favorable properties of their parent agent, including rapid onset of hypnosis and rapid recovery, amnesia, and cardiovascular stability, but do not result in inhibition of steroidogenesis. A few of these analogs have now entered clinical trials and are poised to transform acute care and anesthesia for critically ill patients.