Anesthesia Induction Medications

5 Most Common Anesthesia Induction Agents

Intravenous anesthesia induction agents are a group of fast-acting compounds that are used to induce a state of impaired awareness or complete sedation. The three most commonly used intravenous anesthetics include propofol, etomidate, and ketamine. Two additional agents (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.

For more information on benzodiazepines  and opioids , see the corresponding articles

The most common induction doses referenced in the literature for those agents are as follows.

Propofol-Default Induction medication
-Default medication for TIVA
– no analgesic effects
– respiratory depressant
– caution in hypovolemic patients
-Acts on GABA receptors in the reticular activating system
-rapid bolus can result in profound hypotension.
-Pediatrics 3-15 years old: 2.5-3.0 mg/kg IV push
-Adults with normal cardiovascular system: 2.0-2.5mg/kg IV push
Adults with impaired cardiovascular system: 1.0-1.5mg/kg IV push
Etomidate-Induction option in patients with hemodynamic instability – Little to no effect on the CV system
– Decrease in ICP
-skeletal muscle myoclonic movements
-adrenal suppression
0.2 mg/kg IV push
Ketamine– ER anesthesia for trauma -sympathomimetic effects
– dissociative anesthesia
– increased ICP
– psychotomimetic effects (hallucinations, vivid dreams)
-IV administration: 0.5-2.0 mg/kg (incremental)
– IM administration: 4-5mg/kg (may repeat 2-5mg/kg in 15min )
– PO administration: 6-10mg/kg (once)
Methohexital– IV induction for ECT procedures – Decreased ICP and cerebral blood flow.
– high lipid solubility
– cytochrome P450 induction
Not commonly used in Peds
1-1.5mg / kg in adults
Thiopental-IV induction agents – not suited for IV infusions
– caution in hypovolemia
– anti-epileptic effects.
Pediatrics 1-12 yo: 5-6 mg/kg IV push
Adults: 3-4 mg/kg IV push
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