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General anesthesia: Intravenous induction agents

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 "General anesthesia: Maintenance and emergence".)

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

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

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Literature review current through: Nov 2017. | This topic last updated: May 24, 2017.
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