Pediatric Anesthesiology
Induction Principles and Technics - 4

Intravenous Induction

If an IV line is already present, then intravenous induction is certainly the easiest and most efficient. Thiopental, 3 to 7 mg/kg (7 mg/kg in healthy young infants after the neonatal period) is still the gold standard. More expensive, but also effective, is propofol, 2 to 3 mg/kg. Unfortunately, propofol injection is often painful. Lidocaine, 0.25 to 0.5 mg/kg IV, just before or with the propofol seems to minimize this pain. If administered as an infusion of 500 mcg/kg/min for up to 4 to 6 minutes until the patient loses consciousness, apnea or hypotension is unlikely. In special circumstances, other agents (ketamine, 1 to 2 mg/kg, or etomidate, 0.3 to 0.4 mg/kg) may be used.
Some clinicians are quite skilled in the efficient insertion of small butterfly needles in hand or foot veins. If EMLA cream has been appropriately applied and a syringe of thiopental previously attached to the butterfly tubing, the induction can be rapid and painless.

Greg Gordon MD