Rapid sequence intubation induction agents for adults

Drug name	Class	Benefits	Contraindications	Notes	Dose
Etomidate	Imidazole derivative	Excellent sedation with little hypotension	Known to suppress adrenal cortisol production	Use cautiously if patient has sepsis; initial dose of glucocorticoid may be needed	0.3 mg/kg
Ketamine	Phencyclidine derivative, dissociative anesthetic	Stimulates catecholamine release Bronchodilation	Use in patients with elevated ICP or elevated blood pressure is controversial	May be an excellent induction agent for patients with bronchospasm, septic shock, AND hemodynamic compromise	1 to 2 mg/kg
Midazolam	Benzodiazepines	Potent dose-related amnesic properties	Dose-related myocardial depression can result in hypotension	Frequently underdosed	0.2 to 0.3 mg/kg
Propofol	Alkylphenol derivative	Bronchodilation	No absolute contraindications		1.5 to 3 mg/kg
Propofol	Alkylphenol derivative	Bronchodilation	Dose-related hypotension		1.5 to 3 mg/kg
Thiopental sodium	Ultrashort-acting barbiturate	Cerebroprotective and anti-convulsive properties	Potent venodilator and myocardial depressant; can cause hypotension	May not be commercially available. Rarely used.	3 to 5 mg/kg
			Relatively contraindicated in reactive airway disease due to histamine release
			Acute intermittent and variegate porphyrias

Graphic 64272 Version 10.0