Etomidate

0.3 mg/kg

Shock: 0.15 mg/kg

Onset: 30–45 s

Duration: 5–15 min

May suppress adrenal cortisol production; use cautiously in sepsis; consider hydrocortisone 100 mg IV ×1

Minimal hypotension; ideal for hemodynamic instability

Ketamine

1–2 mg/kg

Shock: 1 mg/kg

Onset: 45–60 s

Duration: 10–20 min

Beneficial in bronchospasm, septic shock, and hemodynamic compromise

Minimal respiratory depression

Causes catecholamine release, stimulant effects

CI: elevated ICP or BP

Midazolam

0.1–0.3 mg/kg

Onset: 30–60 s

Duration: 15–30 min

Amnesic properties

Dose-related hypotension

Propofol

1.5–2.5 mg/kg

Onset: 15–45 s

Duration: 5–10 min

Bronchodilation

Respiratory depression, dose-related hypotension

Succinylcholine

1–1.5 mg/kg

Use total BW

Onset: 30–60 s

Duration: 5–10 min

Depolarizing NMBA

Second dose can cause bradycardia (treat with atropine, see Table 3.1 )

NMBA of choice except for malignant hyperthermia, neuromuscular disease, muscular dystrophy, stroke or burn over 48 h old, rhabdomyolysis, significant hyperkalemia

Rocuronium

1 mg/kg

Use ideal BW

Onset: 45–60 s

Duration: 30–45 min

Preferred nondepolarizing NMBAs due to shorter onset and duration compared to other agents in the same class

Vecuronium

0.1 mg/kg

Onset: 3–4 min

Duration: 35–45 min

Alternative nondepolarizing NMBA to rocuronium

Pancuronium is not recommended due to tachycardia and histamine release and longer onset and duration compared to other NMBAs

Sugammadex:

• •
  

  A reversal agent for rocuronium and vecuronium; a rescue agent if unable to intubate/ventilate

  
  
• •
  

  Routine reversal of rocuronium or vecuronium: 2–4 mg/kg

  
  
• •
  

  Immediate reversal of rocuronium: 16 mg/kg

  
  
• •
  

  Risk of bradycardia: monitor electrocardiogram

  
  
• •
  

  Risk of anaphylaxis: have resuscitation drugs readily available

  
  
• •
  

  Use not recommended in CrCl <30 and dialysis

Neostimine

• •
  

  A reversal agent for nondepolarizing NMBAs

  
  
• •
  

  Only give when there is adequate recovery (train-of-four ≥10% of baseline)

  
  
• •
  

  Dose: 0.05–0.07 mg/kg IV ×1

  
  
• •
  

  Glycopyrrolate IV (0.2 mg for each 1 mg of neostigmine) should be given prior to or in conjunction with neostigmine