Etomidate inhibits 11β-hydroxylase, an enzyme important in adrenal steroid production. Continuous infusion of etomidate for sedation in intensive care units may increase mortality as patients may be unable to respond to stress. Decreased plasma concentrations of cortisol may occur with 0.3 mg/kg induction doses. Transient skeletal muscle movements occur frequently. Disturbing movements (e.g. myoclonic, tonic, ocular, and averting movements) occur occasionally. Cardiac depression (decreased heart rate and cardiac index) and decreased mean arterial blood pressure may occur in geriatric patients, especially those with hypertension. Risk of severe adverse reactions may be increased in impaired renal function (drug is substantially excreted by kidneys). I.V. solution is highly irritating.