• Ann Pharmacother · Jan 2014

    Review

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

    • Joanna L Stollings, Daniel A Diedrich, Lance J Oyen, and Daniel R Brown.
    • Vanderbilt University Medical Center, Nashville, TN, USA.
    • Ann Pharmacother. 2014 Jan 1;48(1):62-76.

    ObjectiveTo 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 SourceA search of Medline databases (1966-October 2013) was conducted.Study Selection And Data ExtractionDatabases 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 SynthesisData were reviewed to support the use or avoidance of premedications, induction agents, and paralytics and combinations to consider when drug shortages occur.ConclusionsRSI 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.

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