In pediatric Facilitated Laryngoscopy/Supraglottic Airway, what is the alternative induction option besides Etomidate?

• A. Propofol 1 mg/kg
• B. Ketamine 1 mg/kg (Diluted)
• C. Rocuronium 1 mg/kg
• D. Fentanyl 1 mcg/kg

Answer: (B)

In this setting, the main idea is choosing an induction agent that allows the child to maintain spontaneous breathing and airway reflexes during airway management. Ketamine fits that need well because it provides anesthesia and analgesia while preserving or only minimally depressing spontaneous respiration. It also tends to preserve cardiovascular tone in children and has bronchodilatory effects, which can be advantageous in pediatric airways. Using a diluted IV dose around 1 mg/kg helps achieve dissociative anesthesia with controllable depth while keeping the patient breathing on their own during the procedure, making it a strong alternative to Etomidate.

Propofol, while a common induction agent, often leads to significant respiratory depression and hypotension, which can be problematic when you want to maintain spontaneous ventilation during airway maneuvers. Rocuronium is a paralytic, so it would abolish spontaneous breathing and airways reflexes, requiring complete ventilation support rather than facilitating a breath-through approach. Fentanyl alone provides analgesia but does not reliably produce the depth of anesthesia needed for airway manipulation and can still depress respiration; it’s not a standalone induction agent here. ketamine’s unique profile in this context is what makes it the best option.