Sedative and Analgesic Medications for Induction of Intubation
Medication | Dose (IV) | Considerations |
|---|---|---|
Propofol* | 0.5–1 mg/kg (loading dose) and 0.25–0.5 mg/kg (subsequent maintenance doses) | A medication that is used to induce sedation and amnesia very quickly (< 1 minute) |
Etomidate† | 0.1–0.15 mg/kg over 1 minute (loading dose) | Etomidate does not provide pain relief and may require the use of a short-acting synthetic opioid |
Midazolam‡ | 0.02–0.03 mg/kg (as 0.5–1 mg loading dose) | A short-acting analgesic (minimal sedation); the maximum single dose should not exceed 2.5 mg |
Fentanyl§, ¶ | 0.5 mcg/kg every 2 minutes | A short-acting synthetic opioid;the initial dose is 50-100 mcg for adults, and the maximum total dose is 5 mcg/kg (or approximately 250 mcg) |
Ketamine¶ | 1–2 mg/kg over 1–2 minutes (loading dose) and 0.25–0.5 mg/kg (maintenance dose) | Ketamine a short-acting dissociative sedative; doses should be adjusted when used in combination with other sedatives or in patients with obesity (based on ideal body weight not actual weight) |
* Data from Miner JR, Burton JH: Clinical practice advisory: Emergency department procedural sedation with propofol. Ann Emerg Med 50(2):182–187.e1, 2007. doi:10.1016/j.annemergmed.2006.12.017 | ||
† Data from Miner JR, Danahy M, Moch A, Biros M: Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department. Ann Emerg Med 49(1):15–22, 2007. doi:10.1016/j.annemergmed.2006.06.042 | ||
‡ Data from Horn E, Nesbit SA: Pharmacology and pharmacokinetics of sedatives and analgesics. Gastrointest Endosc Clin N Am 14(2):247–268, 2004. doi:10.1016/j.giec.2004.01.001 | ||
§ Data from Hikma. Fentanyl citrate injection [package insert]. U.S. Food and Drug Administration website.019101s063lbl.pdf (fda.gov). Revised December 15, 2023. Accessed June 11, 2024 and from Brown TB, Lovato LM, Parker D: Procedural sedation in the acute care setting. Am Fam Physician 2005;71(1):85–90, 2005. | ||
¶ Data from David H, Shipp J: A randomized controlled trial of ketamine/propofol versus propofol alone for emergency department procedural sedation. Ann Emerg Med 57(5):435–441, 2011. doi:10.1016/j.annemergmed.2010.11.025 and from Brown TB, Lovato LM, Parker D: Procedural sedation in the acute care setting. Am Fam Physician 71(1):85–90, 2005. | ||