5 most common anesthesia induction agents
· Updated
Intravenous anesthesia induction agents are a group of fast-acting compounds used to induce a state of impaired awareness or complete sedation. The three most commonly used intravenous anesthetics are propofol, etomidate and ketamine. Two additional agents, the barbiturates methohexital and thiopental, are less commonly used.
Propofol is the standard drug for induction of anesthesia, and etomidate is most commonly used in cases of hemodynamic instability. Ketamine plays a key role in emergency medicine because of its strong dissociative, sympathomimetic and analgesic effects.
The induction doses most commonly referenced in the literature for these agents are as follows.
| Medication | Indication | Characteristics | Dose |
|---|---|---|---|
| Propofol | Default induction medication. Default medication for TIVA. | No analgesic effect. Respiratory depressant. Caution in hypovolemic patients. Acts on GABA receptors in the reticular activating system. A rapid bolus can cause profound hypotension. | Pediatrics 3 to 15 years: 2.5 to 3.0 mg/kg IV push. Adults with a normal cardiovascular system: 2.0 to 2.5 mg/kg IV push. Adults with an impaired cardiovascular system: 1.0 to 1.5 mg/kg IV push. |
| Etomidate | Induction option in patients with hemodynamic instability. | Little to no effect on the cardiovascular system. Decreases ICP. Skeletal muscle myoclonus. Adrenal suppression. | 0.2 mg/kg IV push. |
| Ketamine | Emergency anesthesia for trauma. | Sympathomimetic effects. Dissociative anesthesia. Increased ICP. Psychotomimetic effects (hallucinations, vivid dreams). | IV: 0.5 to 2.0 mg/kg (incremental). IM: 4 to 5 mg/kg (may repeat 2 to 5 mg/kg in 15 min). PO: 6 to 10 mg/kg (once). |
| Methohexital | IV induction for ECT procedures. | Decreases ICP and cerebral blood flow. High lipid solubility. Cytochrome P450 induction. | Not commonly used in pediatrics. 1 to 1.5 mg/kg in adults. |
| Thiopental | IV induction agent. | Not suited to IV infusion. Caution in hypovolemia. Anti-epileptic effects. | Pediatrics 1 to 12 years: 5 to 6 mg/kg IV push. Adults: 3 to 4 mg/kg IV push. |
Add these doses under the Induction medications category in your PediSafe app, at the doses you use in your practice.
Reference only. Verify every dose against current references and the needs of the individual patient.