The Pharmacology of Physiologically Difficult Airway Management and Impact on Hemodynamics: A Review

Critically ill patients have a physiologically difficult airway (PDA), wherein tracheal intubation (TI) and transition to positive pressure ventilation may lead to cardiorespiratory and other complications. Medications administered during the management of a PDA, have an impact on peri-intubation hemodynamics, and may influence patient outcomes. Appropriately choosing, and dosing medications, such as anesthetic induction agents, neuromuscular blocking agents (NMBAs) etc. are thus important considerations that clinicians should be aware of. However, despite significant awareness, and research in this area, there remains ambiguity in the choice of such drugs. This review provides an update on the pharmacology of airway management in patients with a PDA, discussing medications administration strategies widely used in this patient population. We review the current evidence related to the use of anesthetic induction agents, neuromuscular blocking agents, vasopressors, inotropes, and adjunctive agents and provide updated guidance on appropriate medication selection in the context of airway management in patients with a PDA. How to cite this article: Karamchandani K, Khawaja A, Chaney W, Bangalore R, Myatra SN. The Pharmacology of Physiologically Difficult Airway Management and Impact on Hemodynamics: A Review. Indian J Crit Care Med 2026;30(1):68-76.