Lesson 9 of 15
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Summary of Induction Agents

Jimmy September 8, 2021

Why Do We Use Induction Agents?

To ensure adequate sedation to a patient prior to paralysis and endotracheal intubation

Summary of Induction Agents for RSI

DrugDosingOnset Duration Adverse Effect
Etomidate 0.3 mg/kg IV 15-45 seconds
4-15 minutes Injection site pain, nausea, vomiting, myoclonus, adrenal suppression
Ketamine 1-2 mg/kg IV

4-10 mg/kg IM
30 seconds 5-10 minutes Hypertension, tachycardia, emergence phenomenon
Propofol 1-2 mg/kg IV
5-45 seconds 3-10 minutes Hypotension, bradycardia
Midazolam 0.1-0.3 mg/kg IV
60-90 seconds15-30 min Respiratory depression, apnea, and hypotension

Hemodynamics of Common Induction Agents

DrugHemodynamic EffectComments
Etomidate↔ BP, ↔ CO, ↔ HR, ↓ cortisol, ↔ ICPProlonged inhibition of steroid synthesis in the critically ill; withdrawn from a number of countries
Ketamine↑BP, ↑ HR, ↑ CO, ↔ cortisol, ↑↓ ICP ↔ or ↑ CPP and ↔ ICP with standard anesthetic management
Propofol↓ BP, ↓ HR,↓ CO, ↔ cortisol, ↓ ICPHemodynamic compromise marked in elderly, ASA 3 or more or hypovolemic patients with ‘standard’ induction dose
Midazolam ↓ BP, ↓ HR,↓ CO, ↔ cortisol, ↓ ICP Mild hypotension