Which of the following is the BEST induction plan for resection of a known pheochromocytoma in a child?
a) IM ketamine, IV placement, propofol, rocuronium
b) PO midazolam, inhalational induction, lidocaine, fentanyl, propofol, rocuronium
c) PO midazolam, IV placement, lidocaine, fentanyl, pancuronium
d) PO clonidine, inhalational induction, rocuronium
Answer b. Agents that cause catecholamine release (ketamine, ephedrine), inhibit catecholamine reuptake (droperidol), cause tachycardia (pancuronium, desflurane) or sensitize the myocardium to cardiac dysrhythmia (succinylcholine, halothane) are best avoided. Because laryngoscopy is a known precipitant of catecholamine surge a surgical level of anesthesia should be achieved prior to attempts at laryngoscopy; answer B ensures this depth of anesthesia better than answer D.