Which induction agent is shown to be effective for patients with reactive airways disease and is commonly used in COPD-like hyperinflation scenarios?

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

Answer: (C)

In reactive airway disease and COPD‑like hyperinflation, you want an induction agent that minimizes bronchospasm and helps keep the patient breathing spontaneously. Ketamine fits this well because it provides bronchodilation and preserves spontaneous respiration and airway reflexes during induction. This reduces the risk of bronchospasm and dynamic airway obstruction that can occur with other agents. It also tends to maintain blood pressure and heart rate, which can be advantageous in a stressed or hypoxic patient. One practical note is that ketamine can increase secretions, so clinicians may counter that with an anticholinergic if needed, but the overall airway and ventilation benefits make it the best choice in this scenario. Propofol can depress respiration and may provoke poorer airway dynamics, etomidate offers hemodynamic stability but lacks bronchodilatory effects, and dexmedetomidine isn’t a primary induction agent.