Oral transmucosal etomidate produces dose-related increases in sedation and clinically significant serum concentrations. Animal studies documented etomidate as highly permeable through the buccal mucosa with rapid onset and offset suggesting that oral transmucosal etomidate might be useful when brief mild to moderate sedation with rapid recovery is desirable.
Oral transmucosal etomidate exhibited linear pharmacokinetics with continuous infusion and the decrease in plasma concentration of etomidate after stopping the infusion was consistent with a three- compartment pharmacokinetic model.
This is what Miller’s anesthesia says about Oral transmucosal etomidate –
Etomidate is an imidazole derivative (R-(+)-pentylethyl-1H-imidazole-5 carboxylate sulfate). Its chemical structure is illustrated in Figure.
With a molecular weight of 342.36 kD, etomidate exists as two isomers, the (+) isomer being the one active as a hypnotic. Etomidate is water insoluble and is unstable in a neutral solution. It has been formulated with several solvents.
In the United States, it is supplied as a 2-mg/mL propylene glycol (35% by volume) solution with a pH of 6.9 and an osmolality of 4640 mOsm/L. In Europe, lipid emulsion has been introduced in an attempt to reduce some of the side effects of etomidate.
In contrast to sodium thiopental, when etomidate is mixed with other commonly used anesthetics, such as neuromuscular blockers, vasoactive drugs, or lidocaine, it does not cause precipitation.