Agent	Recommended dosing	Onset	Duration	Comments
Etomidate	Sedation in adults: 0.2 mg per kg over 30 to 60 seconds	Less than one minute	Three to five minutes	Advantages: single agent, reliable, no cardiovascular or respiratory depression, first-line agent in adults Disadvantages: limited data with PSAA, action too short for some procedures
Ketamine	Sedation in children: 1 to 2 mg per kg intravenously	One minute	10 to 20 minutes	Reliable, established safety in children, intramuscular route, first-line agent in children; not approved by the U.S. Food and Drug Administration for children younger than 16 years*
	Sedation in children: 2 to 4 mg per kg intramuscularly	Five minutes	15 to 45 minutes	Nystagmus, hypersecretions, agitation, emergence delirium, vomiting, myoclonus, laryngospasm, cardiovascular stimulation, may require concurrent atropine sulfate in children younger than five years †
				Contraindications: hypertension, ischemia, increased intracranial or intraocular pressure, active respiratory infection, psychosis, infants younger than three months
Atropine sulfate	Children: 0.01 mg per kg intravenously/intramuscularly Minimum: 0.1 mg Maximum: 0.5 mg	Less than one minute intravenously Five minutes intramuscularly	2 hours	Use in children younger than five years to counteract vagal effects of ketamine.*
Fentanyl	Initial dose in adults: 1 to 1.5 mcg per kg intravenously	One to two minutes	30 minutes	Familiarity, availability, reversibility, proven safety record, minimal cardiovascular depression*
	Titrate: 1 mcg per kg every three minutes intravenously			Cough, hiccup, itching, vomiting, respiratory depression, requires another agent for sedation, poor reliability, repeat dosing usually required †
Midazolam	Initial dose in adults: 0.02 mg per kg Titrate: 1 mg intravenously every three minutes Initial dose in children six months to five years of age: 0.1 mg per kg	One to two minutes	30 minutes	Familiarity, availability, proven safety record* Requires another agent for analgesia, poor reliability, repeat dosing usually required, respiratory depression, hypotension †
Naloxone	Adults: 0.1 to 2.0 mg intravenously	One minute	15 to 30 minutes	Opiate reversal, very safe, but routine use NOT recommended
Flumazenil	Adults: 0.2 mg per minute intravenously Maximum: 1.0 mg every 20 minutes	One minute	45 minutes	Benzodiazepine reversal, use discouraged, potential for benzodiazepine withdrawal or status epilepticus