Related Experiment Video
Updated: Jun 23, 2026
05:39
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Sedation after intubation using etomidate and a long-acting neuromuscular blocker.
Dawn B Kendrick1, Kathy W Monroe, David W Bernard
1Department of Pediatrics, Division of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Pediatric Emergency Care
|May 22, 2009
Summary
Many pediatric patients intubated with etomidate and paralytics may not receive timely additional sedation, risking paralysis without adequate comfort. Emergency physicians must consider this gap in care during rapid sequence intubation.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Pharmacology
Background:
- Etomidate is a short-acting hypnotic used in rapid sequence intubation.
- Its short duration contrasts with long-acting paralytics, risking paralysis without sedation.
- Adequate sedation is crucial for intubated pediatric patients.
Purpose of the Study:
- To determine how often pediatric patients receive additional sedation after etomidate and a paralytic.
- To assess the timing of additional sedative administration.
Main Methods:
- Retrospective review of pediatric endotracheal intubations (2001-2005).
- Included patients receiving etomidate with rocuronium or vecuronium.
- Excluded patients with seizures; analyzed medication timing and patient disposition.
Main Results:
- 84 pediatric patients were analyzed.
- Mean time to additional sedation was 46 minutes.
- 13.1% received no additional sedative; 63.1% received it >15 minutes after etomidate.
Conclusions:
- A significant number of pediatric patients experience prolonged paralysis without adequate sedation.
- Physicians must be aware of this risk when using etomidate and paralytics.
- Timely administration of additional sedatives is critical.
Related Concept Videos
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
01:22Stages of General Anesthesia
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
01:31Skeletal Muscle Relaxants: Therapeutic Uses
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
01:27Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions
Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Although all competitive neuromuscular blockers are designed...
01:28Depolarizing Blockers: Mechanism of Action
Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because succinylcholine...
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because succinylcholine...
01:21Skeletal Muscle Relaxants: Adverse Effects
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Unlike...