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Ann Pharmacother. 2014 Jan;48(1):62-76. doi: 10.1177/1060028013510488. Epub 2013 Nov 4.

Rapid-sequence intubation: a review of the process and considerations when choosing medications.

Author information

1
Vanderbilt University Medical Center, Nashville, TN, USA.

Abstract

OBJECTIVE:

To summarize published data regarding the steps of rapid-sequence intubation (RSI); review premedications, induction agents, neuromuscular blockers (NMB), and studies supporting use or avoidance; and discuss the benefits and deficits of combinations of induction agents and NMBs used when drug shortages occur.

DATA SOURCE:

A search of Medline databases (1966-October 2013) was conducted.

STUDY SELECTION AND DATA EXTRACTION:

Databases were searched using the terms rapid-sequence intubation, fentanyl, midazolam, atropine, lidocaine, phenylephrine, ketamine, propofol, etomidate thiopental, succinylcholine, vecuronium, atracurium, and rocuronium. Citations from publications were reviewed for additional references.

DATA SYNTHESIS:

Data were reviewed to support the use or avoidance of premedications, induction agents, and paralytics and combinations to consider when drug shortages occur.

CONCLUSIONS:

RSI is used to secure a definitive airway in often uncooperative, nonfasted, unstable, and/or critically ill patients. Choosing the appropriate premedication, induction drug, and paralytic will maximize the success of tracheal intubation and minimize complications.

KEYWORDS:

etomidate; induction agents; ketamine; neuromuscular blockers; premedications; propofol; rapid-sequence intubation

PMID:
24259635
DOI:
10.1177/1060028013510488
[Indexed for MEDLINE]

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