Which option correctly lists the pediatric induction medications and their dosages?

• A. Etomidate 0.2 mg/kg IV/IO max 10 mg; Ketamine 1 mg/kg IV/IO max 100 mg or 2 mg/kg IM max 200 mg; Midazolam 0.05 mg/kg IN/IM/IV/IO titrated to effect, max 3 mg
• B. Etomidate 0.4 mg/kg IV/IO max 25 mg; Ketamine 3 mg/kg IV/IO max 300 mg or 6 mg/kg IM max 600 mg; Midazolam 0.2 mg/kg IN/IM/IV/IO titrated to effect, max 7 mg
• C. Etomidate 0.3 mg/kg IV/IO max 20 mg; Ketamine 2 mg/kg IV/IO max 200 mg or 4 mg/kg IM max 400 mg; Midazolam 0.1 mg/kg IN/IM/IV/IO titrated to effect, max 5 mg
• D. Etomidate 0.5 mg/kg IV/IO max 30 mg; Ketamine 1 mg/kg IV/IO max 100 mg; Midazolam 0.4 mg/kg IN/IM/IV/IO titrated to effect, max 6 mg

Answer: (C)

In pediatric induction, the goal is to achieve rapid unconsciousness with stable hemodynamics, while keeping the airway protected and allowing titration of sedation. The best dosing set uses an induction dose of etomidate that provides quick onset with minimal cardiovascular impact, a ketamine dose that offers dissociative anesthesia with preserved airway reflexes and spontaneous breathing, and a midazolam dose that adds anxiolysis and amnesia and can be given by several routes with careful titration.

Etomidate at 0.3 mg/kg IV or IO up to a 20 mg ceiling is a classic pediatric induction dose. It acts quickly to produce hypnosis with minimal change in blood pressure, making it favorable when stability is a concern. Ketamine at 2 mg/kg IV or IO (max 200 mg) or 4 mg/kg IM (max 400 mg) provides analgesia and anesthesia while typically preserving airway reflexes and maintaining spontaneous respiration, which is advantageous in children who may have difficult airway management. Midazolam at 0.1 mg/kg given intranasally, intramuscularly, intravenously, or intraosseously, titrated to effect with a max of 5 mg, adds anxiolysis and amnesia and is flexible in routes for kids who may not have IV access yet; dosing is kept within a limit to avoid excessive sedation.

The other option sets use doses that are either lower than typical induction needs or higher, increasing risks of inadequate anesthesia or oversedation, respectively. This combination—etomidate 0.3 mg/kg, ketamine 2 mg/kg IV/IO or 4 mg/kg IM with specified caps, and midazolam 0.1 mg/kg titrated to effect up to 5 mg—best aligns with common pediatric induction practice and safety considerations.