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Controversies in rapid sequence intubation in children
Audrey Zelicof-Paul1, Arlene Smith-Lockridge, David Schnadower
1Department of Pediatrics, Emergency Division, The Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Current Opinion in Pediatrics
|May 14, 2005
Summary
Rapid sequence intubation (RSI) in children requires careful consideration of clinician expertise, premedications, sedatives like etomidate, and neuromuscular blockers. Protocols can guide rational, scenario-based RSI in the emergency department.
Area of Science:
- Pediatric Emergency Medicine
- Anesthesiology
- Critical Care
Background:
- Rapid sequence intubation (RSI) is the standard for emergency department (ED) intubations.
- Controversies exist regarding optimal RSI practices in pediatric patients.
Purpose of the Study:
- To review controversies in pediatric emergency department RSI.
- To provide evidence-based guidance for RSI procedures in children.
Main Methods:
- Literature review of current practices and evidence.
- Analysis of clinician roles, premedications, sedative agents, and neuromuscular blockers.
Main Results:
- ED physicians can perform RSI effectively with training.
- Limited data on atropine and lidocaine use.
- Etomidate is a preferred sedative with low cardiovascular risk.
- Succinylcholine is often preferred for neuromuscular blockade, with predictable side effects.
- Rocuronium offers an alternative but has a longer duration.
Conclusions:
- Further research is needed for pediatric RSI.
- Available data support developing rational, scenario-based RSI protocols for children.