arisen, however due to etomidate’s side effect of 11β-hydroxylase blockade and subsequent decreased serum cortisol Whereas prolonged infusions of etomidate can increase mortality in critically ill adult patients, it is not clear that a single dose given in an emergency setting results in clinically significant adrenal suppression in pediatric patients More research is needed on this subject However, the 2010 International Consensus on Cardiopulmonary Resuscitation states that etomidate should not be routinely used in children and infants presenting with septic shock, or if used, practitioners should be aware of risk of adrenal insufficiency Etomidate may be useful in certain rapidly performed procedures such as anterior shoulder dislocations, joint aspirations, and incision and drainage, however, a small number of patients experience clinically significant myoclonus Another common side effect of etomidate is vomiting during recovery The usual dose is 0.3 mg/kg when used for induction in RSI In PSA, the suggested dose is 0.1 to 0.3 mg/kg Propofol Propofol is an ultra–short-acting sedative-hypnotic with no analgesic properties Propofol has gained favor in the ED because it has a rapid onset of action, a rapid offset, and some antiemetic and amnesic properties However, this potent sedative has a relatively narrow therapeutic range, and the incidence of partial airway obstruction and apnea is slightly higher than other standard regimens Transient hypotension is expected with administration of this agent, albeit more common in patients with hypovolemia or fragile cardiovascular status A number of studies using propofol in pediatric ED patients have indicated excellent efficacy and safety, demonstrating short recovery times and shorter overall ED times Some clinicians have begun using propofol in conjunction with an opiate medication such as fentanyl or alfentanil; however, this increases the risk of adverse events Notably, the procedures performed in these studies were limited to brief, intensely painful experiences, which seem to be best suited for this medication regimen The volume of distribution and elimination of propofol is the same in children as it is in adults, making dosing recommendations similar It is administered slowly as a bolus dose of mg/kg, supplemented by 0.5 mg/kg aliquots every minutes A continuous infusion rate of 50 to 150 mcg/kg/minute is preferred for procedures of