For a patient with hyperinflated lungs, which induction agent is preferred to facilitate endotracheal intubation?

• A. Propofol
• B. Etomidate
• C. Midazolam
• D. Ketamine

Answer: (D)

When a patient has hyperinflated lungs, you want an induction agent that reduces bronchial resistance and preserves spontaneous ventilation to avoid worsening air trapping during intubation. Ketamine fits this need because it provides bronchodilation, helping to relax the airway smooth muscle, and it tends to maintain spontaneous breathing and hemodynamic stability during induction. This combination makes airway management smoother in hyperinflated lungs and lowers the risk of bronchospasm or dynamic hyperinflation as you secure the airway.

Propofol, while widely used, often depresses respiration and can provoke bronchospasm in reactive airways, which complicates induction in this setting. Etomidate is hemodynamically stable and causes less respiratory depression but does not offer bronchodilation, so it lacks the benefit needed for hyperinflated lungs. Midazolam can depress respiration and airway reflexes without providing bronchodilation. Therefore, ketamine is the best choice here.