Which intravenous induction agent should be avoided in an elderly patient with specific medical history?

The choice to avoid ketamine as an intravenous induction agent in an elderly patient stems from its psychological side effects and potential cardiovascular impacts, particularly important when considering the common comorbidities in older adults. Ketamine is known to cause hallucinations and agitation during emergence, which can be particularly distressing for elderly patients who may already have cognitive decline or other psychiatric conditions.

Furthermore, ketamine acts as a dissociative anesthetic, which might not be suitable for all elderly patients, especially if they have a history of cardiovascular issues or other medical conditions that could be exacerbated by its sympathomimetic effects.

In contrast, etomidate, propofol, and fentanyl have different profiles that can be more favorable in specific elderly patient scenarios. Etomidate is often used for its minimal cardiovascular effects and is commonly considered for patients with hemodynamic instability. Propofol provides rapid induction and recovery, with less risk of disorientation in comparison to ketamine. Fentanyl, although an opioid, can be used carefully in elderly populations if adjusted for dosage considering their sensitivity to opioids.

In summary, ketamine’s side effects and potential for complicating existing medical issues, especially in the elderly, make it the preferred choice to avoid