What are the recommended drugs for anesthesia induction?

From the Guidelines

The most recommended drug for anesthesia induction is propofol, due to its rapid onset and short duration, as well as its ability to decrease laryngeal reactivity compared to sevoflurane 1. When considering anesthesia induction, several factors must be taken into account, including the patient's age, comorbidities, and the planned procedure.

• Propofol is typically administered at 1.5-2.5 mg/kg IV for healthy adults, providing rapid onset and short duration.
• Sevoflurane is also a viable option, particularly in pediatric patients, as it has been shown to decrease sub-glottic airway reactivity compared to propofol 1.
• Etomidate and ketamine are alternative options, often used in specific situations such as hemodynamic instability or hypovolemia.
• The choice of induction agent should be individualized based on patient factors, and dosages should be adjusted accordingly to prevent adverse hemodynamic effects.
• In pediatric patients with upper respiratory tract infections, sevoflurane may be preferred over desflurane due to its decreased association with airway resistance 1.
• The use of opioids like fentanyl or remifentanil, and neuromuscular blocking agents such as rocuronium or succinylcholine, may also be considered to facilitate intubation and blunt sympathetic response.

From the FDA Drug Label

Induction of General Anesthesia Adult Patients Most adult patients under 55 years of age and classified as ASA-PS I or II require 2 mg/kg to 2. 5 mg/kg of propofol injectable emulsion for induction when unpremedicated or when premedicated with oral benzodiazepines or intramuscular opioids. Pediatric Patients Most patients aged 3 years through 16 years and classified ASA-PS I or II require 2.5 mg/kg to 3. 5 mg/kg of propofol injectable emulsion for induction when unpremedicated or when lightly premedicated with oral benzodiazepines or intramuscular opioids.

The recommended drugs for anesthesia induction are:

• Propofol (IV): 2 mg/kg to 2.5 mg/kg for adult patients, and 2.5 mg/kg to 3.5 mg/kg for pediatric patients
• Ketamine (IV): no specific dosage is provided in the label for induction of anesthesia, but it is mentioned as an option for procedures of the pharynx, larynx, or bronchial tree 2 3

From the Research

Anesthesia Induction Drugs

The following are some of the recommended drugs for anesthesia induction:

• Propofol: a rapidly acting intravenous anesthetic agent with many advantageous kinetic properties, making it useful for induction of anesthesia or administration by continuous intravenous infusion 4, 5, 6, 7, 8
• Ciprofol (HSK3486): a structural analog of propofol, demonstrating a promising trend of higher anesthesiologists' satisfaction during the induction phase, with comparable efficacy and safety to propofol for anesthesia induction and maintenance in adult patients undergoing surgery 7

Characteristics of Anesthesia Induction Drugs

Some key characteristics of these drugs include:

• Propofol: rapid distribution in the body, efficient hepatic and extrahepatic clearance, and rapid recovery with almost no hangover effect 4
• Propofol: higher incidence of cardiorespiratory depression, but absence of tachycardiac response prevents increase in cardiac oxygen demands 4
• Ciprofol: advantages in terms of pain management, with comparable efficacy and safety to propofol for anesthesia induction and maintenance in adult patients undergoing surgery 7

Dosage and Administration

The dosage and administration of these drugs can vary depending on the patient and the procedure:

• Propofol: induction dose of 2.2 mg/kg for younger patients and 1.7 mg/kg for older patients, with maintenance doses of 10.0 mg/kg/h and 8.6 mg/kg/h, respectively 6
• Propofol: infusion rates can affect the induction dose-response relation, with faster infusion rates resulting in shorter induction times and lower induction doses 8