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 - 2 mcg/kg | 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) May cause hypotension |
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. 2007;50(2):182-187.e1. 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. 2007;49(1):15-22. 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. 2004;14(2):247-268. doi:10.1016/j.giec.2004.01.001 | ||
§ Data from American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Airway Management, Godwin SA, Hahn SA, et al. Clinical Policy: Critical Issues in the Management of Adult Patients Requiring Endotracheal Intubation in the Emergency Department. Ann Emerg Med. 2025;86(2):e29-e68. doi:10.1016/j.annemergmed.2025.04.003. and from Brown TB, Lovato LM, Parker D. Procedural sedation in the acute care setting. Am Fam Physician. 2005;71(1):85-90. | ||
¶ Data from David H, Shipp J. A randomized controlled trial of ketamine/propofol versus propofol alone for emergency department procedural sedation. Ann Emerg Med. 2011;57(5):435-441. 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. 2005;71(1):85-90. | ||
