Increase in Venous Complications Associated With Etomidate Use During a Propofol Shortage: An Example of Clinically Important Adverse Effects Related to Drug Substitution Article

PMID: 21734854 Web of Science: 000420223100011

Cited authors

  • Kosarek, Logan; Hart, Stuart R.; Schultz, Lucy; DiGiovanni, Neil


  • Etomidate is a widely used intravenous induction agent that is especially useful for patients at risk for hypotension during anesthesia induction. Side effects limiting its use include adrenocortical suppression, acidosis, myoclonus, venous irritation, and phlebitis. The osmolality of etomidate prepared in propylene glycol appears to play a crucial role in causing phlebitis. The increased use of etomidate during the recent propofol shortage correlated with an increase in reported incidences of postoperative phlebitis and thrombophlebitis at Ochsner Clinic Foundation from October 2009 through April 2010. Several methods aim to prevent such occurrences, including pretreatment with lidocaine (and possibly esmolol), lower doses of etomidate, and injection into larger veins. The most compelling evidence suggests that using a lipid formulation of etomidate instead of the traditional propylene glycol preparation may dramatically decrease venous sequelae.

Publication date

  • 2011

Published in

International Standard Serial Number (ISSN)

  • 1524-5012

Start page

  • 143

End page

  • 146


  • 11


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