Progress and Prospect of Forensic Toxicological Studies on Etomidate

Etomidate is a non-barbiturate intravenous anesthetic. After intravenous administration, it binds to plasma albumin and distributes into brain and heart tissues rapidly. Etomidate has the characteristics of rapid onset, short duration, and stable circulation. It is mainly used in clinical anesthesia induction or short-term surgical anesthesia. Due to its anesthetic properties, abusers make it into smoke powder, smoke oil, etc., and add them to e-cigarettes, which have widespread hazards and high concealment. Long-term use of etomidate will cause damage to the endocrine system, liver and nervous system. The toxicity to nerve cells is particularly prominent. In severe cases, apnea or even death may occur. At present, the abuse of etomidate has become a global issue, and a certain abuse trend also exists in China. Because etomidate is easy to obtain, teenagers account for the vast majority of users, which seriously endangers their physical and mental health. On September 6, 2023, the State Drug Administration, the Ministry of Public Security and the National Health Commission jointly issued the Announcement on the Adjustment of the List of Narcotic Drugs and Psychotropic Substances, which included etomidate (except for etomidate-containing drug preparations approved for marketing in China) on the list of category Ⅱ psychotropic drugs, but the phenomenon of abuse is still frequent. At present, the research on etomidate mainly focuses on clinical medication, adverse reactions and detection methods. However, the research on toxicokinetics, toxicological mechanism and abuse or addiction mechanism is still insufficient. In this paper, the pharmacokinetics, anesthesia mechanism, toxicity, and abuse status of etomidate were retrospectively analyzed, and the detection methods such as gas chromatography-mass spectrometry (GC-MS), high performance liquid chromatography-mass spectrometry (HPLC-MS) and quantitative nuclear magnetic resonance spectroscopy (NMR) were summarized, in order to provide reference for the in-depth study and forensic identification of etomidate.