RSI is used to secure a definitive airway in often uncooperative, nonfasted, unstable, and/or critically ill patients. Citations from publications were reviewed for additional references.ĭata were reviewed to support the use or avoidance of premedications, induction agents, and paralytics and combinations to consider when drug shortages occur. All rights reserved.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.Ī search of Medline databases (1966-October 2013) was conducted.ĭatabases were searched using the terms rapid-sequence intubation, fentanyl, midazolam, atropine, lidocaine, phenylephrine, ketamine, propofol, etomidate thiopental, succinylcholine, vecuronium, atracurium, and rocuronium. © American Society of Health-System Pharmacists 2022. Oxygenation paralysis pharmacist rapid sequence intubation sedation. Purpose: The dosing, potential adverse effects, and clinical outcomes of the most commonly utilized pharmacologic agents for rapid sequence intubation (RSI) are reviewed for the practicing emergency medicine pharmacist (EMP). The EMP is a key member of the bedside care team and uniquely positioned to communicate this evolving data. While the agents used in RSI have changed little, knowledge regarding optimal dosing, appropriate patient selection, and possible adverse effects continues to be gained. RSI involves the administration of an anesthetic induction agent followed quickly by a neuromuscular blocking agent (NMBA) to create optimal intubating conditions and minimize both the duration of the patient's apnea and the time the airway is unprotected.
#Rapid sequence intubation guidelines 2019 update
It is necessary for the practicing EMP to update previous practice patterns in order to continue to provide optimal patient care. Various medications are chosen to sedate and even paralyze the patient to facilitate an efficient endotracheal intubation.
Since then, the role of the EMP as well as the published evidence regarding RSI agents, including dosing, adverse effects, and clinical outcomes, has grown. The usual, nonrapid sequence of induction and intubation for anesthesia consists of administration of an induction agent, proof of the ability to mask ventilate, administration of a neuromuscular blocking agent (NMBA), and endotracheal intubation once paralysis is achieved, usually approximately three minutes after induction. RSI is the process of establishing a safe, functional respiratory system in patients unable to effectively breathe on their own. The mechanism of action and pharmacokinetic/pharmacodynamic profiles of these agents were described in a 2011 review. RSI is the process of establishing a safe, functional respiratory system in patients unable to effectively breathe on their own. The dosing, potential adverse effects, and clinical outcomes of the most commonly utilized pharmacologic agents for rapid sequence intubation (RSI) are reviewed for the practicing emergency medicine pharmacist (EMP).
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