BACKGROUND: Etomidate, an anesthetic induction agent, has dose-dependent involuntary myoclonic movement. This prospective, randomized study was conducted to determine the safety of etomidate in patients with major burn injury. METHODS: Twenty ASA physical status II or III adult patients, scheduled for an elective early escharectomy, were studied. These patients had varying degrees of myoclonic activity at the time of anesthesia induction with etomidate (0.3 mg/kg). The plasma concentrations of potassium before and after myoclonus were measured and compared. RESULTS: Incidence of myoclonus after the injection of etomidate induction dose was 31.7%. No significant changes in plasma concentrations of the potassium level before or after myoclonus were found in this study group. CONCLUSIONS: Myoclonus during induction of anesthesia with etomidate did not cause any change in the plasma concentration of potassium. It appears to be a safe anesthetic induction agent in patients with major burns, threatened by hemodynamic and pulmonary insufficiency.