Induction agents - airway management and intubation
Induction agents are used to induce rapid unconsciousness for rapid sequence induction (RSI) and for deeper procedural sedation. Choice of agent affects haemodynamics, airway reflexes, cerebral and ocular physiology, and post‑intubation sedation needs.
Selection should reflect the patient’s physiology, the intended procedure (RSI versus procedural sedation), and local governance (pre‑intubation checklists, equipment, monitoring and availability of rescue drugs) (RCEM / RCoA; NICE NG39; Resuscitation Council UK).
This section summarises the commonly used induction drugs in UK emergency practice, practical selection principles, key complications and a concise preparation checklist.
Scope and systems considerations
- Drug‑assisted intubation in major trauma and critical illness should follow local RSI protocols and time targets (NICE NG39).
- A designated experienced lead, a pre‑intubation checklist, and immediate access to trained assistants, airway equipment and resuscitation drugs are required (RCEM / RCoA joint statement).
- Monitoring must include continuous ECG, SpO2, non‑invasive blood pressure (or invasive if already present) and mandatory waveform capnography during induction, while the tube is in situ and during transfer (RCEM; Resuscitation Council UK).
- RCEM procedural sedation guidance mandates capnography for deep or dissociative sedation.
- Local protocol and operator familiarity should guide final agent choice and dosing; use trust formularies and anaesthesia colleagues for specific dose adjustments, paediatric regimens and drug availability.
Common induction agents - summary table
Notes...