RSI

Induction agents

Medication	Common source-linked adult IV range	Weight / maximum	Source notes and teaching considerations
Etomidate	0.2–0.3 mg/kg	No standard fixed maximum; obesity scalar not established in labeling.	No analgesia. Myoclonus, apnea, injection pain; cortisol and aldosterone suppression may persist about 6–8 hours.
Ketamine	1–2 mg/kg slowly	No standard fixed maximum; obesity scalar not established in labeling.	Cardiovascular response is variable. Rapid administration may depress respiration; hypotension or cardiac decompensation may occur with catecholamine depletion.
Propofol	1–1.5 mg/kg if older, debilitated, or ASA III–IV; 2–2.5 mg/kg only if healthy and under 55	Body-weight dosing; obesity scalar not specified in labeling.	Dose- and rate-dependent hypotension, apnea, and bradycardia. No analgesia.

Etomidate labelKetamine labelPropofol label2026 ketamine–etomidate RSI trial

RSI

Neuromuscular blockade

Medication	Common source-linked adult IV range	Weight / maximum	Source notes and teaching considerations
Rocuronium	0.6–1.2 mg/kg Common RSI range: 1–1.2 mg/kg	Actual body weight is label-supported at 0.6 mg/kg; the scalar for 1.2 mg/kg in severe obesity remains unsettled.	No unconsciousness, amnesia, or analgesia. Higher doses prolong paralysis; anaphylaxis and prolonged blockade may occur.
Succinylcholine	1–1.5 mg/kg Doses above 1.1 mg/kg exceed current FDA labeling.	Adult obesity scalar is not specified in labeling.	Review hyperkalemia risk, neuromuscular disease, malignant-hyperthermia susceptibility, bradycardia, anaphylaxis, and pseudocholinesterase deficiency.

Rocuronium labelSuccinylcholine labelSCCM adult RSI guideline

After the tube

Analgesia and sedation

Medication	Common source-linked adult IV range	Maximum / status	Source notes and teaching considerations
Fentanyl	25–100 mcg, slowly titrated	No fixed maximum; reassess after each dose.	Respiratory depression, bradycardia, hypotension, CNS-depressant interactions; rapid or high doses may cause chest-wall rigidity.
Propofol infusion	5–50 mcg/kg/min	Avoid >4 mg/kg/hr (about 67 mcg/kg/min) unless benefit outweighs risk.	No analgesia. Hypotension, bradycardia, apnea, hypertriglyceridemia, and propofol infusion syndrome.
Dexmedetomidine	0.2–0.7 mcg/kg/hr	Higher rates and use beyond 24 hours are off-label.	Bradycardia and hypotension. Not sole analgesia and may be inadequate for rapid deep sedation during ongoing paralysis.
Midazolam infusion	0.02–0.1 mg/kg/hr	No authoritative fixed maximum.	Respiratory depression, hypotension, accumulation, prolonged awakening, and delirium risk.

Fentanyl labelDexmedetomidine labelMidazolam labelSCCM PADIS focused update

Source review: 2026-08-06. Medication content was reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP; verify local approval before institutional adoption.