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Intravenous anesthetic induction agents for adults

Liza M Weavind, MBBCh, FCCM, MMHC
Adam King, MD
Section Editor
Girish P Joshi, MB, BS, MD, FFARCSI
Deputy Editor
Nancy A Nussmeier, MD, FAHA


Propofol, etomidate, and ketamine are the intravenous (IV) sedative-hypnotic agents commonly used to induce general anesthesia (table 1). After IV injection, these induction agents have rapid onset due to their high lipid solubility allowing penetration of the blood–brain barrier, and the high proportion of the cardiac output (CO) that perfuses the brain (the effect site). These agents also have a short duration of action due to rapid redistribution from the brain to other tissues, primarily muscle and fat. Typically, one or more adjuvant medications is administered to supplement induction of general anesthesia.

This topic will discuss the advantages, adverse effects, dosing, and pharmacokinetics of the IV sedative-hypnotics (propofol, etomidate, ketamine, methohexital) and adjuvants (opioids, lidocaine, midazolam) during induction of general anesthesia. Selection of an induction technique is discussed separately (see "General anesthesia: Induction"). Other uses of sedative-hypnotics, opioids, and adjuvant agents are discussed in other topics:

(See "Procedural sedation in adults outside the operating room".)

(See "Sedative-analgesic medications in critically ill adults: Selection, initiation, maintenance, and withdrawal".)

(See "Sedative-analgesic medications in critically ill adults: Properties, dosage regimens, and adverse effects".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 11, 2016.
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