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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
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Pharmacotherapy optimization for rapid sequence intubation in the emergency department
Kellyn Engstrom1, Caitlin S Brown1, Alicia E Mattson1
1Department of Pharmacy, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, United States of America.
The American Journal of Emergency Medicine
|May 17, 2023
Summary
Rapid-sequence intubation (RSI) uses specific drugs for airway management in the emergency department. This review covers RSI pharmacotherapies, controversies, and alternatives, highlighting the need for further research in optimal drug selection and administration.
Area of Science:
- Emergency Medicine
- Pharmacology
- Critical Care
Background:
- Rapid-sequence intubation (RSI) is the standard for endotracheal intubation in emergency departments.
- Medication selection is crucial for successful RSI.
- Understanding pharmacotherapy is key for airway management.
Purpose of the Study:
- To review medications used in RSI.
- To discuss clinical controversies in RSI drug selection.
- To examine pharmacotherapy for alternative intubation methods.
Main Methods:
- Literature review of pharmacotherapies for RSI.
- Analysis of current clinical controversies in medication selection.
- Review of alternative intubation pharmacotherapy.
Main Results:
- Etomidate and ketamine are preferred induction agents due to hemodynamic stability.
- Succinylcholine and rocuronium are common neuromuscular blocking agents.
- Pretreatment medication use has declined due to limited evidence.
Conclusions:
- Optimal RSI medication selection and dosing require further research, especially in shock or sepsis.
- Controversies in administration order and dosing in obese patients lack sufficient evidence for practice change.
- More research is needed on awareness with paralysis during RSI.
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