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Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Inhalational Anesthetics: Overview01:20

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Updated: Jun 23, 2026

Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery
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Published on: June 2, 2022

Evaluating Ketamine Dosing Practices During Emergency Department Intubation Using Shock Index Stratification.

Katelyn Gowlett1, Robin Clouston2,3,1, Paul Atkinson2,3,1

  • 1Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, CAN.

Cureus
|June 22, 2026
PubMed
Summary
This summary is machine-generated.

Accurate ketamine dosing for emergency intubation is crucial. This study found about a quarter of patients received doses outside recommended ranges, regardless of their shock index, indicating variability in practice.

Keywords:
emergency medicine researchketamine dosingmedication administrationrapid sequence inductionshock indexendotracheal intubation

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Area of Science:

  • Emergency Medicine
  • Pharmacology
  • Critical Care

Background:

  • Accurate ketamine dosing during rapid sequence intubation (RSI) is vital in emergency settings, especially with hemodynamic instability.
  • Ketamine is used as a sole sedative agent for RSI in adults.
  • Shock index (SI) is a key indicator of hemodynamic status.

Purpose of the Study:

  • To analyze ketamine dosing practices during RSI in a tertiary emergency department.
  • To assess concordance with predefined weight-based and shock index-based dosing ranges.
  • To identify variations in ketamine administration based on hemodynamic status.

Main Methods:

  • Analysis of intubation data from the Emergency Medicine - Airway Registry (EM-AWARE) (2015-2021).
  • Inclusion of adult patients (≥18 years) receiving ketamine as the sole sedative for RSI.
  • Stratification into normal (SI < 0.9) and abnormal (SI ≥ 0.9) shock index groups.

Main Results:

  • 72% of patients with normal SI received ketamine within the predefined range; 28% received doses below.
  • 76% of patients with abnormal SI received reduced doses within the predefined range; 24% received doses outside, mostly above the recommended shock dose.
  • Overall, 24-28% of patients received ketamine doses outside predefined ranges, irrespective of shock index.

Conclusions:

  • Approximately one-quarter of emergency department patients received ketamine doses outside recommended ranges during intubation.
  • Ketamine dosing variability persists during emergency airway management, regardless of patient shock index.
  • Further standardization of ketamine dosing protocols in emergency settings may be warranted.