Which induction agent is commonly used for RSI in hemodynamically stable adults, and what is its typical dose?

• A. Propofol 1-2 mg/kg IV.
• B. Etomidate 0.3 mg/kg IV.
• C. Ketamine 1-2 mg/kg IV.
• D. Rocuronium 0.6-1.2 mg/kg IV.

Answer: (B)

Induction agents for RSI in hemodynamically stable adults are chosen to quickly render the patient unconscious with minimal impact on blood pressure and heart rate. Etomidate fits this goal best because it produces rapid unconsciousness while preserving cardiovascular stability, making it a reliable choice when you don’t want to drop blood pressure during intubation. The typical dose is 0.3 mg/kg given IV, with onset in about 15–30 seconds and a short duration, allowing a swift and smooth intubation.

Propofol, while effective, often causes significant hypotension due to vasodilation and myocardial depression, so it’s less ideal in patients where maintaining blood pressure is a priority. Ketamine increases heart rate and blood pressure, which can be useful in hypotensive patients but is not the usual choice for a stable RSI scenario. Rocuronium is a paralytic, not an induction agent, and is used to facilitate paralysis after the patient is unconscious.