Rapid Sequence Intubation (RSI): Summary of Induction Agents

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

Drug	Dosing	Onset	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 seconds	15-30 min	Respiratory depression, apnea, and hypotension

Drug	Hemodynamic Effect	Comments
Etomidate	↔ BP, ↔ CO, ↔ HR, ↓ cortisol, ↔ ICP	Prolonged inhibition of steroid synthesis in the critically ill; withdrawn from a number of countries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, ↓ ICP	Hemodynamic compromise marked in elderly, ASA 3 or more or hypovolemic patients with ‘standard’ induction dose
Midazolam	↓ BP, ↓ HR,↓ CO, ↔ cortisol, ↓ ICP	Mild hypotension