Airway - Rapid Sequence Induction Agent Guidance
Emergency Medicine - RIE
Warning
All induction agents can cause severe hypotension so take note of cardiovascular status, age and conscious level; the full dose of induction agent may not be appropriate. Induction doses are a guide and should be tailored to the patient and scenario.
| First Choice | ⇒ Ketamine 1-2mg/kg ⇒ Rocuronium 1mg/kg |
In the rare event of needing to immediately reverse muscle relaxation, use Sugammadex 16mg/kg
| Special Circumstances | |
| Concerned about raised ICP | ⇒ Consider adding Fentanyl 1-2mcg/kg |
| Concerned about raised ICP with systemic hypertension | ⇒ Thiopentone 2-5mg/kg ⇒ Fentanyl 1-2mcg/kg ⇒ Rocuronium 1mg/kg |
| Significant tachycardia or severe cardiac disease with hypotension | ⇒ Etomidate 0.1-0.3mg/kg ⇒ Fentanyl 1-2mcg/kg ⇒ Rocuronium 1mg/kg |
| Status epilepticus | ⇒ Thiopentone 2-5mg/kg ⇒ Rocuronium 1mg/kg |
| Major trauma including isolated head injuries | ⇒ See separate guideline - Anaesthesia for damage control resuscitation |
| PLEASE NOTE: Propofol, unless in expert hands, is often a poor 1st choice in critically ill patients due to its narrow therapeutic index. |
Bariatric Patients
| Induction doses should be based on ideal body weight (height in centimetres minus 100 [men] or 105 [women]), with maintenance infusions based on adjusted body weight (ideal weight + 40% of excess) |
Adapted from guidance at sobauk.co.uk