SCCM Resource Library-Intubation Medications

Pdf Summary

The document provides a detailed examination of the pharmacological agents used during endotracheal intubation, a high-risk procedure in hospitals with significant potential for adverse events like hemodynamic instability and cardiac arrest. Rapid sequence intubation (RSI) employs a sedative-hypnotic and a neuromuscular blocking agent (NMBA) to facilitate safe and efficient intubation, improving the first-pass success rate and reducing complications.<br /><br />Key pretreatment agents like Lidocaine, Atropine, Fentanyl, and Esmolol are discussed, primarily for their roles in minimizing physiological responses and adverse effects during intubation. However, their clinical efficacy in critically ill patients is debated. Induction agents such as Etomidate, Ketamine, Midazolam, and Propofol are evaluated for their mechanisms, benefits, and risks in terms of onset, effect duration, and side effects like hemodynamic changes or increased pressure concerns.<br /><br />The document also highlights the significance of NMBAs, particularly Succinylcholine and Rocuronium, in RSI to enhance intubating conditions and manage potential airway difficulties. However, these agents come with specific side effects and considerations, such as hyperkalemia associated with Succinylcholine or prolonged action with Rocuronium.<br /><br />Post-RSI care is crucial, focusing on ensuring adequate sedation and analgesia to prevent awareness and discomfort during paralysis. The guidance suggests post-RSI sedation protocols to mitigate trauma from inadequate care during this critical period.<br /><br />Special scenarios like intubation in patients with conditions like myasthenia gravis or in pregnant patients require tailored approaches, considering altered drug responses and safety for the patient and the fetus.<br /><br />Overall, the document advises careful selection and administration of intubation medications based on patient-specific factors, emphasizing resuscitation before the procedure and vigilant post-intubation care to minimize risks and improve outcomes.

Asset Subtitle

Pulmonary, Pharmacology, 2021, 4:40:00

Asset Caption

This is a complimentary chapter from the textbook, Airway and Mechanical Ventilation Management 2021), titled "Intubation Medications."
Learning Objectives:

Recognize the place in therapy for pharmacological agents used during airway management.
Understand the mechanism of action, pharmacokinetics, and appropriate doses of commonly used medications.
Explain safety concerns related to individual pharmacological agents in critically ill patients.

Meta Tag

Content Type Book Chapter

Knowledge Area Pulmonary

Knowledge Area Pharmacology

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Airway Management

Tag Pharmacology

Year 2021

Keywords

endotracheal intubation

rapid sequence intubation

pharmacological agents

sedative-hypnotic

neuromuscular blocking agent

induction agents

post-RSI care

hemodynamic instability

Lidocaine

Succinylcholine

	Society of Critical Care Medicine 500 Midway Drive Mount Prospect, IL 60056 USA Phone: +1 847 827-6888 Fax: +1 847 439-7226 Email: support@sccm.org	Contact Us About SCCM Newsroom Advertising & Sponsorship DONATE	MySCCM LearnICU Patients & Families Surviving Sepsis Campaign Critical Care Societies Collaborative	GET OUR NEWSLETTER
© Society of Critical Care Medicine. All rights reserved. \| Privacy Statement \| Terms & Conditions The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.