The ideal agent is short-acting with minimal respiratory or hemodynamic depression
Ketamine offers the greatest safety profile overall but caution in the elderly or patients with known cardiovascular disease due to sympathetic surge
Propofol is often used for orthopedic procedures due to muscle relaxation, but can cause respiratory depression and hypotension
Etomidate used less frequently than other agents; causes myoclonus that is undesirable for orthopedic reduction
Dose fentanyl first: 0.5-1mcg/kg
Follow with 1-2 mg of midazolam
Designed for moderate<unk> Too deep when painful stimulus stops the patient may become apneic
Combination of other opioids with benzodiazepines such as lorazepam is possible
Duration 30min
Too deep when painful stimulus stops the patient may become apneic
Combination of other opioids with benzodiazepines such as lorazepam is possible
Similar to fentnayl/midazolam, but better because shorter duration of action
An alternative to propofol for brief<unk> E.g. shoulder/hip reduction, cardioversion
Can cause myoclonus and occaisonly adrenal supression.
Dose fentanyl first: 0.5-1mcg/kg
Etomidate 0.15mg/kg (8-10mg avg)
Duration: 6min
E.g. shoulder/hip reduction, cardioversion
Suppresses the reticular activating center in the brainstem and cerebral cortex, thereby causing<unk><unk>  and amnesia, no analgesia
Dose fentanyl first: 0.5-1mcg/kg
Initial dose 0.75 to 1mg/kg IV
Repeat doses of 0.5mg/kg IV can be given every two minutes.
Immediate onset, duration <10 minutes
Noncompetitive NMDA receptor antagonist that produced dissociative state<unk>  analgesia, and amnesia
Safe to use in children undergoing procedural<unk> and analgesia (Level A recommendation)
Maintains upper airway tone, protective reflexes, and spontaneous breathing
Little evidence to advocate for prevention of emergence phenomenon, may pretreat with midazolam 0.05 mg/kg (2-4 mg for most adults)
Versed can be used subsequently if emergence reaction occurs
Versed can be used subsequently if emergence reaction occurs
1-2 mg/kg IV, followed by 0.5-1 mg/kg IV PRN
4-5 mg/kg IM → repeat 2-4 mg/kg IM after 10 min if first dose unsuccessful
Duration 10 to 20 minutes
Potentiates GABA receptors, sedative hypnotic agent without analgesic properties
Rapid onset <1 min, short duration <10 min, predictable dose dependent potency
0.5-1mg/kg IV over 3-5 mins, repeat 0.5 mg/kg q3-5 min PRN
Can cause dose-related respiratory depression, hypotension, and decreased cardiac output, however, rarely leads to unplanned intubation, prolonged observation, or complications requiring admission 
Can cause sympathomimetic effects, such as tachycardia, hypertension, and increased cardiac output, and caution should be used in patients with known or suspected coronary artery disease
1:1 mixture of ketamine and propofol
Safe in children and adults undergoing procedural<unk> and anesthesia (Level B Reccomendation)
Theorized that side-effect profiles counter one another
Propofol-associated hypotension and respiratory depression can theoretically be reduced with increases in circulatory norepinephrine induced by ketamine
Ketamine associated nausea and emergence reactions are theoretically reduced by the antiemetic and anxiolytic properties of propofol
A study of pediatric patients found the total patient<unk> times to be shorter (3 minutes) with the combined ketamine and propofol regimen compared with ketamine alone
Dose: 0.5mg/kg propofol with 0.5mg/kg ketamine (may be mixed in same syringe or given separately)
Propofol-associated hypotension and respiratory depression can theoretically be reduced with increases in circulatory norepinephrine induced by ketamine
Ketamine associated nausea and emergence reactions are theoretically reduced by the antiemetic and anxiolytic properties of propofol
1 mcg/kg loading dose followed by 0.2-1 mcg/kg/hr maintenance dose
Side effects include bradycardia and hypotension.
Avoid in patients with heart blocks
May need to supplement with 1-2 mg of midazolam
0.1mg/kg one time dosing
Max: 10mg
Minimal respiratory depression but decrease blood pressure and heart rate (alpha2 agonism)
Sedation 
Sedative/hypnotic withdrawal
Insomnia
Extrapyramidal reaction
Altered mental status
Altered mental status 
Baclofen withdrawal
Tremor