Which induction agent is preferred for hemodynamically unstable patients during RSI, and what is its typical dose?

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

Answer: (D)

In hemodynamically unstable patients undergoing rapid sequence intubation, the aim is to achieve quick anesthesia with as little further drop in blood pressure as possible. Ketamine fits this role because it tends to preserve or even raise blood pressure and heart rate by stimulating the sympathetic nervous system and releasing catecholamines, while also providing analgesia and bronchodilation. Its onset is rapid when given intravenously, with an induction dose typically around 1-2 mg/kg IV. By contrast, propofol often causes significant hypotension, etomidate, though hemodynamically stable, can impair adrenal function with repeated dosing, and rocuronium is a paralytic rather than an induction agent. Thus, ketamine at about 1-2 mg/kg IV is the preferred induction agent in unstable patients during RSI.