Induction of Anesthesia

Laryngoscopy and endotracheal intubation are extremely stimulating events that are powerfully resisted by the unanesthetized patient. The goal of RSI is to overcome this resistance while preserving hemodynamic stability. The term induction of anesthesia is used here rather than sedation because, while the distinction between the two is somewhat indistinct, performance of laryngoscopy and intubation without causing major hemodynamic perturbations requires a deep state of anesthesia, for which the term sedation is inappropriate. The drugs commonly used for induction of anesthesia and their pediatric doses are listed in Table 1.1.-4.. Note the absence of opioid agents, which do not reliably induce rapid hypnosis. These doses are appropriate for healthy, well-hydrated patients. The dose for critically ill patients, as well as for those who have received other agents, such as opioid analgesics, should be adjusted downward accordingly. All of these drugs are appropriate for this indication; however, the profiles and side effects of each differ somewhat, as discussed below.

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