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RSI in Traumatic Brain-injured Adults :
- Pretreatment with lidocaine and/or vecuronium is no longer recommended
- Post-intubation continuous sedation medications include a
Normotensive/hypertensive patient : combination of propofol and fentanyl
Hypotensive patient : combination midazolam and fentanyl or ketamine alone
- Pretreatment with lidocaine and/or vecuronium is no longer recommended
- Post-intubation continuous sedation medications include a
Normotensive/hypertensive patient : combination of propofol and fentanyl
Hypotensive patient : combination midazolam and fentanyl or ketamine alone
Ketamine is the only sedative agent that typically preserves ventilation and has minimal effect on blood pressure.
No clear evidence that ketamine is harmful as an induction or sedation agent in patients with potential head injury.
Adverse effect : hypersalivation, laryngospasm, vomiting,
Emergence reactions (mild agitation to recurrent nightmares and hallucinations)
Smaller doses of ketamine cause analgesia and disorientation.
Dissociation occurs when a dosage threshold of 1 - 1.5 mg/kg IV in adult patients.
Higher doses have not been shown to enhance or deepen the sedation.
No clear evidence that ketamine is harmful as an induction or sedation agent in patients with potential head injury.
Adverse effect : hypersalivation, laryngospasm, vomiting,
Emergence reactions (mild agitation to recurrent nightmares and hallucinations)
Smaller doses of ketamine cause analgesia and disorientation.
Dissociation occurs when a dosage threshold of 1 - 1.5 mg/kg IV in adult patients.
Higher doses have not been shown to enhance or deepen the sedation.
Etomidate
Less cardiovascular depression but a similar degree of respiratory depression
Associated with adrenal insufficiencyincreased mortality in critically ill patients
No analgesic effect
Associated with adrenal insufficiencyincreased mortality in critically ill patients
No analgesic effect
Propofol
Most serious adverse effect of propofol is sudden respiratory depression and apnea
Hypotension, Hypovolemia should be corrected before propofol administration.
In the elderly,initial and subsequent doses should be 50%
Benzodiazepines, etomidate, or propofol are sometimes used alone.
These agents do not provide pain relief and should not be used as the sole agent
when pain management is also desired.
Hypotension, Hypovolemia should be corrected before propofol administration.
In the elderly,initial and subsequent doses should be 50%
Benzodiazepines, etomidate, or propofol are sometimes used alone.
These agents do not provide pain relief and should not be used as the sole agent
when pain management is also desired.
NMB agents 本來就不應該是常規給, 而是視臨床適應症而選擇是否要做 RSI
如果病人沒有 IICP 又年老瘦弱無力, 只要 deep sedation intubation 就夠了
如果是 difficult airway 就該考慮 Awake intubation (by 張志華)
如果病人沒有 IICP 又年老瘦弱無力, 只要 deep sedation intubation 就夠了
如果是 difficult airway 就該考慮 Awake intubation (by 張志華)
<所以也是很多地方只打 sedation 就插管 ... >
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