Etomidate
Classification: imidazole derivative
Dosing: 0.3mg/kg total body weight
Onset: 15-30 s
Duration: 3- 5 m
Benefits: minimal hemodynamic effects, rapid onset, anxiolysis
Considerations: known to cause adrenal suppression and controversial data on outcomes in severe sepsis and septic shock patients
Wells RM., Murphy MF. Clinical controversies: Etomidate as an induction agent for endotracheal intubation in patients with sepsis. Ann Emerg Med. 2008;52(1):13–14
Mohammad Z., Afessa B., Finkielman JD. The incidence of relative adrenal insufficiency in patients with septic shock after the administration of etomidate. Crit Care. 2006;10:R105
Ketamine
Class: PCP derivative
Dosing: 1-2mg/kg IV, 4-5mg IM ideal body weight
Onset: 30 s
Duration: 10-15 m
Benefits: analgesia, dissociation, amnesia, rapid onset, hemoprotective, bronchodilation
Considerations: laryngospasm, emergence reactions, increased secretions, hypertension, consideration in dissection/MI. Historic consideration in head trauma/increased ICP
Propofol
Class: phenol derivative
Dosing: 1.5-2.5mg/kg IV total body weight
Onset: 15-45 s
Duration: 5-10 m
Benefits: analgesia, amnesia, anxiolysis, anti-epileptic
Considerations: frequent apnea, hypotension, painful injection, reduced cerebral perfusion, myocardial depression, soybean or egg allergy
Fentanyl
Class: synthetic opioid
Dosing: 2-10mcg/kg IV total body weight
Onset: 60 s
Duration: 30-60 m
Benefits: analgesia, minimal hemodynamic effects
Considerations: historic use in blunt sympathomimetic response, ex increased ICP. Depressed respiratory drive/apnea, reports of muscular rigidity.
Philip W. H. Peng, MBBS, FRCPC, Alan N. Sandler, MBChB, MSc, FRCPC; A Review of the Use of Fentanyl Analgesia in the Management of Acute Pain in Adults. Anesthesiology 1999;90(2):576-599.
Midazolam
Class: Benzodiazepine
Dosing: 0.3mg/kg IV total body weight
Onset: 1-5 m
Duration: 30 – 60 m
Benefits: sedation, amnesia, anxiolysis, anti-epileptic
Considerations: no analgesia, moderate hypotension, variable response, respiratory depression
Nordt SP, Clark RF. Midazolam: a review of therapeutic uses and toxicity. J Emerg Med 1997; 15:357.
Succinylcholine
Class: depolarizing neuromuscular blockade
Dosing: 1-1.5mg/kg IV, 2-3mg/kg IM
Onset: 30-60 s IV, 2-3 m IM
Duration: 5-10 m IV, 10-20 m IM
Benefits: Rapid onset and brief duration, IV/IM administration
Considerations: bradycardia, hyperkalemia ie crush injuries, burns, dialysis, increased ocular pressure, increased intracranial pressure, malignant hyperthermia, increased dosing in neuromuscular disorders, defasciculations may increase oxygen consumption
Rocuronium
Class: non-depolarizing neuromuscular blockade
Dosing 0.6-1.2mg/kg IV
Onset: 45-60 s
Duration: 30-90 m
Benefits: minimal contraindications, considered equal to or better to succinylcholine when using upper limit of dosing
Considerations: long duration of action
5minuteairway 