Induction Agents
Medication | Weight-Based Dosing | Time to Onset of Action | Adverse Effects/Contraindications |
Etomidate | 0.3 mg/kg (TBW) | <1 minute | May cause clinically insignificant adrenal suppression. |
Ketamine | 1-2 mg/kg (IBW) | 1-3 minutes | May increase blood pressure. May cause hypersalivation. |
Propofol | 2 mg/kg (IBW+) | <1 minute | May cause hypotension. Cardiac depressant. Contraindicated in egg/soybean allergy |
Midazolam | 0.3 mg/kg (TBW) | 1-5 minutes | May cause hypotension |
TBW: Total Body Weight, IBW: Ideal Body Weight, IBW+: IBW + 0.4 X (TBW-IBW)
Paralytics
Medication | Weight-Based Dosing | Time to Onset of Action | Adverse Effects/Contraindications |
Succinylcholine | 1.5 – 2.0 mg/kg (TBW) | 45-60 seconds | Bradycardia. Malignant hyperthermia. Hyperkalemia. |
Rocuronium | 1.2 mg/kg (TBW) | 45-60 seconds | |
Vecuronium | 0.1 mg/kg (IBW) | 2-4 minutes | Questionable RSI utility when rocuronium available |
Post-Intubation Sedation
Medication | Weight-Based Dosing | Notes |
Midazolam | 0.04-0.2 mg/kg/hr (TBW) | Short duration, but with long-term use has long half-life. Often used with fentanyl |
Propofol | 5-80 mcg/kg/min (IBW+) | Propofol Infusion Syndrome with long term use: monitor TG, amylase/lipase |
Dexmedetomidine | 0.2-0.7 mcg/kg/hr (TBW) | |
Ketamine | 0.5-1 mg/kg/hr (IBW) | May decrease bronchospasm |
Fentanyl | 1-2 mcg/kg bolus25-250 mcg/hr (TBW) |
Read More
EM Updates: Resus Medication Dosing of Obese Patients
References
- Greenwood, John C., ed. PressorDex. Irving, TX: Emergency Medicine Residents’ Association; 2013