ASH ED RSI Induction Agents- 'sedation'
Terms in this set (7)
Used to reverse neuromuscular blockade after administration of non-depolarizing neuromuscular-blocking agents such as vecuronium or rocuronium.
•Onset: 60-90 sec
•Duration: 10-20 min•Use: any RSI, especially if hemodynamically unstable (OK in TBI, does not increase ICP despite traditional dogma) or if reactive airways disease (causes bronchodilation).
Draw backs: increased secretions, caution in cardiovascular disease (hypertension, tachycardia), laryngospasm (rare), raised intra-ocular pressure
•Onset: 30-45 sec
•Duration: 5-10 min
•Use: any RSI if haemodynamically stable, status epilepticus
•Drawbacks: histamine release, myocardial depression, vasodilation, hypotension.
•Onset: 15-45 seconds
•Duration: 5 - 10 minutes
•Use: Haemodynamically stable patients, reactive airways disease, status epilepticus
•Drawbacks: hypotension, myocardial depression, reduced cerebral perfusion, pain on injection, variable response, very short acting
•Onset: <60 seconds (maximal at ~5 min)
•Duration: dose dependent (30 minutes for 1-2 mcg/kg, 6h for 100 mcg/kg)
•Use: may be used in a low dose as a sympatholytic premedication (e.g. TBI, SAH, vascular emergencies); may used in a'modified' RSI approach in low doses or titrated to effect in cardiogenic shock and other hemodynamically unstable conditions
•Drawbacks: respiratory depression, apnea, hypotension, slow onset, nausea and vomiting, muscular rigidity in high induction doses, bradycardia, tissue saturation at high doses
•Onset: 60-90 sec
•Duration: 15-30 min
•Use: not usually recommended for RSI, some practitioners use low doses of midazolam and fentanyl for RSI of shocked patients
•Drawbacks: respiratory depression, apnea, hypotension, paradoxical agitation, slow onset, variable response
What is an Induction Agent?
RSI incorporates a rapidly acting sedative (i.e., induction) agent, in addition to a neuromuscular blocking (i.e., paralytic) agent, to create optimal intubating conditions.
When a paralytic agent is used for intubation without sedation, the patient may be fully aware of his or her environment, including pain, but unable to respond. In addition to its inhumanity, this circumstance allows for potentially adverse physiologic responses to airway manipulation, including tachycardia, hypertension, and elevated intracranial pressure. Sedative use prevents or minimizes these effects.
Furthermore, clinicians can sometimes select an induction agent that both facilitates RSI and ameliorates the patient's underlying condition. As an example, ketamine can be used in severe asthma to reduce bronchospasm.
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