Pretreatment drugs for RSI (2024)

FAQs

Pretreatment drugs for RSI? ›

Traditionally there are four options for pretreatment for Rapid Sequence Intubation (RSI): atropine 20 mcg/kg IV — prevent bradycardia in children. lignocaine 1.5mg/kg IV — sympatholytic, neuroprotection in head injury; decrease airway reactivity in asthma.

Traditionally there are four options for pretreatment for Rapid Sequence Intubation (RSI): atropine 20 mcg/kg IV — prevent bradycardia in children. lignocaine 1.5mg/kg IV — sympatholytic, neuroprotection in head injury; decrease airway reactivity in asthma.

Efforts to premedicate for RSI and prevent detrimental responses to LTI center on the use of four medications or classes of medications. The mnemonic “LOAD” may be used to recall the pre-medication co*cktail consisting of lidocaine, opiates (largely fentanyl), atropine, and defasciculating neuromuscular blocking agents.

Suxamethonium (succinylcholine): It is the most common muscle relaxant used in RSI. Rocuronium: It takes effect within 45-60 seconds. Pharmacological adjuncts include the following: Fentanyl.

Commonly used premedications including fentanyl, midazolam, and atropine; induction agents including etomidate and ketamine; paralytics including rocuronium and succinylcholine; and reversal agents including naloxone, flumazenil, and paralytics are reviewed.

Instead of titrating to effect, RSI involves administration of weight-based doses of an induction agent (eg, ketamine, etomidate) immediately followed by a paralytic agent (eg, rocuronium, succinylcholine) to render the patient unconscious and paralyzed within 1 minute.

RSI utilizes a sedative, a short term paralytic, and a long term paralytic when necessary. In addition, atropine is used for bradycardic patients, and lidocaine is used for patients with increased intracranial pressure (ICP). Because of the nature of RSI, not all paramedics are eligible and close scrutiny is required.

Over-the-counter NSAIDs like aspirin or ibuprofen can reduce pain and inflammation. Talk to your provider before taking NSAIDs for longer than 10 days.

The goal of preoxygenation is to maximize the amount of oxygen in the lung, primarily in the functional residual capacity (FRC), and therefore to delay the onset of hypoxia during apnea. This involves "washing out" the nitrogen that is the primary gas in alveoli when breathing room air.

What benzo is used for RSI? ›

However, when other medications are used (ie, fentanyl), respiratory depression can occur. Because of midazolam's excellent pharmaco*kinetic profile and amnestic properties, it is the authors' opinion that midazolam is the most preferred benzodiazepine for use in a RSI.

Physiotherapy. If your symptoms do not improve, you may be referred for physiotherapy. As well as massaging the affected area, a physiotherapist can show you exercises to help strengthen your muscles and improve your posture.

Suxamethonium is the most commonly used muscle relaxant during RSI, but non-depoloarizers may have to be used when the former is contraindicated. Suxamethonium Its rapid onset, short duration of action as well as good quality of muscle relaxation makes sumethonium14 the ideal muscle relaxant for RSI.

Pretreatment before intubation

Noninvasive ventilation (NIV) or high-flow nasal cannula (HFNC) can be used to aid preoxygenation (1). Even in apneic patients, such preoxygenation has been shown to improve arterial oxygen saturation and prolong the period of safe apneic time (2).

Propofol, etomidate, and ketamine or in combination with benzodiazepines and opioids are commonly used sedative agents administered for endotracheal intubation. Propofol demonstrates rapid onset and offset, however, has drawbacks of profound vasodilation and associated cardiac depression.

[4] Common sedative agents used during rapid sequence intubation include etomidate, ketamine, and propofol. Commonly used neuromuscular blocking agents are succinylcholine and rocuronium. Certain induction agents and paralytic drugs may be more beneficial than others in certain clinical situations.

You should be able to treat your symptoms at home by following R.I.C.E.: Rest: Avoid the activity that caused your injury. Don't overuse the injured part of your body while it heals. Ice: Apply a cold compress to your injury 15 minutes at a time, a few times a day.

When used at a dose of 1.2 mg/kg, rocuronium has a similar onset time to succinylcholine. Because succinylcholine has several clinical contraindications and rocuronium has no contraindications (except for hypersensitivity to the agent), debate about the paralytic agent of choice for RSI has persisted for several years.