Imidazole hypnotic that enhances GABA-A receptor activity. Produces rapid unconsciousness with minimal effect on blood pressure, heart rate or contractility. No analgesic effect.
Dosing
Adult
0.3 mg/kg IV (typical 20 mg)
Pediatric
0.2–0.3 mg/kg IV (age >10 in labeling; used off-label younger)
Indications
Induction for rapid sequence intubation, particularly in hemodynamically unstable patients
Contraindications
Hypersensitivity
Use with caution in septic shock or known adrenal insufficiency (transient adrenal suppression)
Side effects
Transient adrenal suppression (inhibits 11-beta-hydroxylase for 6–24 hours after one dose)
Myoclonus
Pain on injection
Nausea and vomiting
Monitoring parameters
Blood pressure
SpO2 and ETCO2 confirmation after intubation
Need for post-intubation sedation (short duration)
Drug interactions
Additive effect with other sedatives; give with a neuromuscular blocker for RSI