Induction of Anesthesia for Intubation

Medications for Induction

The American Society of Anesthesiologists recommends propofol 100 mg IV (2 mg/kg) for induction of anesthesia in patients weighing 50 kg 1, 2
Fentanilo 25-50 mcg IV (0.5-1 mcg/kg) is recommended as an analgesic opioid for induction of anesthesia in patients weighing 50 kg 2, 4
Rocuronio 30 mg IV (0.6 mg/kg) is recommended as a neuromuscular blocking agent for induction of anesthesia in patients weighing 50 kg 3
The American Academy of Pediatrics recommends etomidato 10-20 mg IV (0.2-0.4 mg/kg) as an alternative to propofol in hemodynamically unstable patients 4
Midazolam 5-10 mg IV (0.1-0.2 mg/kg) can be used as an alternative sedative for induction of anesthesia in patients weighing 50 kg 2, 5

Glicopirrolato 0.2 mg IV (0.004 mg/kg) can be used as an antisialagogue to reduce secretions during intubation 1, 2
Atropina 0.2-0.3 mg IV (0.004-0.006 mg/kg) can be used as an antisialagogue and to prevent bradycardia during intubation 1, 2, 3

In patients with anticipated difficult airway, consider awake intubation using topical anesthesia 1, 2
In hemodynamically unstable patients, reduce the dose of propofol to 50-75 mg (1-1.5 mg/kg) or consider using etomidato 4
Consider using ketamina 50-100 mg IV (1-2 mg/kg) as an alternative to propofol in hemodynamically unstable patients 5

Hipotensión can be managed with fluid administration and/or vasopresors 6
Desaturación can be managed with mask ventilation and 100% oxygen 2
Intubación difícil can be managed by following a difficult airway algorithm and having alternative devices available 1
Bradicardia can be managed with atropina 0.5 mg IV 2