In adult post‑intubation sedation/paralysis for an advanced airway, what is the recommended ketamine dose?

In adult post‑intubation sedation/paralysis for an advanced airway, what is the recommended ketamine dose?

• A. Ketamine: 100-200 mg IV/IO (Diluted)
• B. Fentanyl: 100 mcg SLOW push IV/IO (Repeat 1x in 20 min)
• C. Rocuronium: 1 mg/kg IV/IO (Minimum dose: 50 mg/Maximum dose: 100 mg)
• D. Midazolam: 5 mg IV

Answer: (A)

Ketamine is chosen here for its rapid onset, analgesic effect, and ability to provide sedation without necessarily compromising airway reflexes in the immediate post-intubation period. For an adult with an advanced airway, a bolus of about 1–2 mg/kg is effective, and many protocols specify a practical fixed range of 100–200 mg IV or IO to accommodate different body weights while ensuring rapid deeper sedation. Diluting the dose helps achieve precise administration and reduces the risk of giving too concentrated a bolus too quickly, which aids in controlled onset and duration of action. After this bolus, ongoing sedation can be maintained with an infusion if needed. Other drugs listed serve different roles—analgesia or paralysis—so ketamine’s bolus within this range is the most appropriate single-dose approach for immediate post-intubation sedation with an advanced airway.

Ketamine is chosen here for its rapid onset, analgesic effect, and ability to provide sedation without necessarily compromising airway reflexes in the immediate post-intubation period. For an adult with an advanced airway, a bolus of about 1–2 mg/kg is effective, and many protocols specify a practical fixed range of 100–200 mg IV or IO to accommodate different body weights while ensuring rapid deeper sedation. Diluting the dose helps achieve precise administration and reduces the risk of giving too concentrated a bolus too quickly, which aids in controlled onset and duration of action. After this bolus, ongoing sedation can be maintained with an infusion if needed. Other drugs listed serve different roles—analgesia or paralysis—so ketamine’s bolus within this range is the most appropriate single-dose approach for immediate post-intubation sedation with an advanced airway.