How should the bolus dose of medication administered via ET compare to the standard IV dose?

The bolus dose of medication administered via endotracheal (ET) tube is often adjusted due to differences in absorption and distribution compared to intravenous (IV) administration. When delivering medication via the ET route, the dosage typically needs to be increased—often doubled—because the bioavailability and effects can vary significantly from that of an IV route.

This increase accounts for the fact that the ET route bypasses the normal circulatory absorption processes and may lead to delayed onset of action. Therefore, to achieve therapeutic effects comparable to the IV administration, the bolus dose should be increased. Doubling the dose can help ensure that adequate medication reaches systemic circulation effectively and promptly when delivered via the ET route.

In contrast, halving the dose or keeping it the same would likely not produce sufficient effects, while tripling it may lead to overdosing, introducing unnecessary risks for the patient. Therefore, the most appropriate adjustment is to double the bolus dose for ET administration.