used as induction agent for intubation as general sedative or in rapid sequence induction (RSI)
rapid onset of action usually within 60 seconds (may be 5-15 seconds) with duration of action of 3-5 minutes (may be up to 14 minutes)
no analgesic activity; minimal respiratory or cardiovascular effects
Special access product
Dose:
0.3 mg/kg (0.2-0.6 mg/kg) to usual maximum of 20 mg IV
Consider dose reduction in elderly patients
Extensively excreted by kidney; patients with renal impairment may be more likely to experience toxic reactions. Specific dosing guidelines are not available.
Administration:
IV direct over 30-60 seconds
use large proximal arm veins or central line if possible to avoid pain on injection
Adverse Effects:
Injection site pain
Hypotension or hypertension
Tachycardia or bradycardia
Arrhythmias
Hypoventilation or hyperventilation, apnea
Seizures
Laryngospasm, hiccoughs
Nausea/vomiting
Dose related transient skeletal muscle movements including myoclonus (often masked by neuromuscular blockers)
prolonged suppression of cortisol and aldosterone synthesis with continuous infusion or repeated dosing
Monitoring Therapy:
Continuous heart rate and rhythm
Blood pressure
Respiratory rate
Oxygen saturation
End-tidal CO2
Adult Critical Care Protocol:
Must be administered by MD trained in airway management with patient specific approval from senior resident or CCTC consultant.
Monitoring sheet must be completed by administering physician and returned to Pharmacy Department.
Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC Last Reviewed: September 20, 2018; February 13, 2023
