pediatric rapid sequence intubation drugs

#Pediatric rapid sequence intubation drugs plus

1.5mg/kg - better to overdose than to underdose.May decrease MAP, especially if patient hypovolemic.Consider in patient in status epilepticus (anti-seizure effect).Consider in patient with CHF (nitro-life effect → decrease ventilator filling pressure).Consider use in head injured patients with increased ICP AND low or normal BP Evidence for clinically significant rise in ICP equivocal at best.Also consider with hypotension (i.e.: septic shock) Agent of choice for asthmatics as it has bronchodilator effects.Adrenal suppression is likely irrelevant with one-time dose.Does NOT blunt sympathetic reaction to intubation (no analgesic effect).Lowers seizure threshold in patients with known seizure disorder.Especially good for hypotensive/trauma patients.Reactive Airway disease: Lidocaine 1.5mg/kg (suppresses cough reflex).Increased ICP: Fentanyl 3-5mcg/kg (+/- lidocaine 1.5mg/kg (some think drop in MAP not worth it)).Ischemic heart disease/dissection: Fentanyl 3-5mcg/kg.Apneic oxygenation with NC at 6L/min while setting up and increase to 15L/min once patient is sedated.100% NRB for 3-5min or 8 VC breaths (BVM) with high-flow O2.SOAPME: (Suction, oxygen, airway, pharmacology, monitoring, equipment).

#Pediatric rapid sequence intubation drugs plus

Option 2: 1 mcg/kg fentanyl PLUS 1 mg/kg ketamine PLUS 1 mg/kg rocuronium.

Option 1: 0.15 mg/kg etomidate PLUS 1.5 mg/kg succinylcholine.

Option 2: 2 mcg/kg fentanyl PLUS 2 mg/kg ketamine PLUS 1 mg/kg rocuronium.

Option 1: 0.3 mg/kg etomidate PLUS 1.5 mg/kg succinylcholine.

Hemodynamically stable, normotensive, well perfusing.

However, etomidate and succinylcholine produces less hypotension.

Etomidate does not have analgesic properties.

Fentanyl with ketamine and rocuronium may blunt hypertensive response to tracheal manipulation as compared to traditional etomidate and succinylcholine RSI.

Consider decreasing induction agent dosage for hemodynamic compromise.

agent of choice for prolonged paralysis.

Duration - 65 minutes (95% complete recovery).

0.02mg/kg, no minimum dose (prior minimum 0.1mg no longer recommended).

There is no evidence to support the routine use of atropine as a premedication to prevent bradycardia in emergency pediatric intubations Rapid sequence intubation (RSI) is an airway management technique that produces immediate anesthesia via an induction agent as well as rapid paralysis via a neuromuscular blocking agent.