A 68-year-old woman requires emergency intubation. She has a full stomach and is haemodynamically unstable. Which induction agent is MOST appropriate to attenuate the hypertensive response to laryngoscopy while preserving cardiovascular stability?

• A Thiopentone 5 mg/kg
• B Propofol 2 mg/kg
• C Ketamine 1–2 mg/kg ✓
• D Etomidate 0.3 mg/kg

Explanation

Ketamine is a dissociative agent that stimulates sympathetic outflow, thereby maintaining or increasing heart rate and blood pressure, making it the induction agent of choice in haemodynamically unstable patients. It also provides profound analgesia and amnesia. Propofol and thiopentone cause significant vasodilation and myocardial depression, worsening haemodynamic instability. Etomidate preserves haemodynamics but does not attenuate the sympathetic response to laryngoscopy as effectively as ketamine, and carries the risk of adrenocortical suppression.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.