Drugs for Rapid Sequence Intubation

Drugs Used for Induction (1)

Dosage: Stable, 0.3 mg/kg IVP, unstable, 0.15 mg/ kg IVP; onset, 30 s
Onset: 30–60 s
Duration: 3–5 min
Indications: Multitrauma; existing hypotension
Cautions: Inhibits cortisol synthesis; decreases focal seizure threshold

Dosage: Stable, 2 mg/kg IVP; unstable, 0.5 mg/kg
Onset: 9–50 s
Duration: 3–10 min
Indications: Isolated head injury; status epilepticus
Cautions: Hypotension; lecithin allergy

Dosage: Stable, 3 mg/kg IVP; unstable, 1.5 mg/kg IVP; onset, 30 s
Onset: 30–60 s
Duration: 5–30 min
Indications: Normotensive; normovolemic before barbiturate therapy for status epilepticus or   control of intracranial hypertension
Cautions: Bronchospasm; hypotension; poor availability because of controlled drug status

Dosage: 2 mg/kg IVP
Onset: 1–2 min
Duration: 5–15 min
Indications: Asthma/COPD
Cautions: Head injury; ischemic heart disease; hypertensive emergencies

Dosage: 0.2–0.4 mg IVP
Onset: 10 min
Duration: 2 h
Indications: Uncompensated shock
Cautions: Tachycardia

Neuromuscular Blocking Agents (2)

Dosage: 1.5 mg/kg IV push
Onset, s: 30–60
Duration, min: 5-15
Indications: Use as default paralytic agent unless there is contraindication
Cautions: Contraindications: personal or family history of malignant hyperthermia; likely    difficult intubation or mask ventilation; known uncontrollable hyperkalemia; myopathy;  chronic neuropathy/stroke; denervation illness or injury after greater than 3 d; crush injury after  greater than 3 d; sepsis after greater 7 d; severe burns after greater than 24 h
Caution: chronic renal insufficiency

Dosage: High dose: 1 mg/kg IV push
Onset, s: 45–60
Duration, min: 45–70
Indications: When succinylcholine is contraindicated
Cautions: Predict difficult intubation and ventilation; allergy to aminosteroid                   neuromuscular blocking agents

(1) Airway Management of the Critically Ill Patient: Rapid Sequence Intubation. Chest, 2005. Table 3,  Drugs Used For Induction, p. 1402  Available at https://chestjournal.chestpubs.org/content/127/4/1397.full.pdf

(2) Ibid., Table 4,  Neuromuscular blocking agents, p. 1404  Available at https://chestjournal.chestpubs.org/content/127/4/1397.full.pdf

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