INTUBATION MEDICATIONS

INTUBATION MEDICATIONS 

Specific Agents 

Sedatives-Hypnotics: rapid onset of unconsciousness (0.5 to 1 minute) and short duration of action

Thiopentone sodium (Pentothal)
• a barbiturate
• 2-5 mg/kg
• increased venous capacitance _ decreased preload___CO and _BP
• Hypovolemic patients and those with poor cardiac reserve are prone to hypotension with induction
• Increased HR
• Useful as induction agent and brief sedation
• Respiratory depression can be significant

Propofol (Diprivan)
• an isopropyl phenol
• 1-2.5mg/kg
• more rapid and complete awakening compared to barbiturates
• reduces blood pressure more than thiopental
• exaggerated hemodynamic effects in hypovolemic patients
• pain with injection into non-antecubital, small vein

Antianxiety agents
Amnestic, anticonvulsant, hypnotic, and sedative effects. Useful sedation for procedures and toleration of mechanical ventilation.

Benzodiazepines

Midazolam
• sedation: 0.5-1 mg increments
• induction: 0.15-0.35 mg/kg
• amnestic: 50 mcg/kg
• mild vasodilatation
• respiratory depression: increased in the elderly and when combined with narcotics
• onset 1 - 2 mins. and recovery 30 - 120 mins.

Diazepam
• sedation: 2 - 10mg (adults)
• onset 1 -2 mins. and recovery 2 - 4 hrs.
Muscle relaxants
FULL VENTILATORY SUPPORT IS MANDATORY

Suxamethonium chloride
• depolarising muscle relaxant
• indications: facilitate tracheal intubation, provide skeletal muscle relaxation during surgery or mechanical ventilation
• intubation: 0.5-1.5 mg/kg
• onset: 60 seconds
• recovery time: 3-10 minutes
• Cardiac dysrhythmia including sinus bradycardia, junctional rhythm, and sinus arrest have been reported. May cause tachycardia in adults and bradycardia in children
• significant hyperkalemia may result in patients with skeletal muscle myopathy, neurologic deficits, prolonged bed rest, multiple trauma, major burns (safe within first 24 hours of burn)
• risk of hyperkalemia peaks at 7-10 days post burn, neurologic injury or multiple trauma
• Use in children should be reserved for emergency intubation or instances where immediate securing of the airway is necessary.
• Increases intraocular, intragastric and intracranial pressure

Vecuronium bromide (Norcuron)
• steroidal analogue of pancuronium
• intubation: 0.08-1 mg/kg
• onset: ~ 3 minutes
• duration: 20-35 minutes
• hemodynamically benign

Pancuronium bromide
• Intubation: 0.1 mg/kg
• onset: 3-5 minutes
• duration: 60-90 minutes
• 10-15% increase in HR, arterial BP and CO

Local Anesthetics

Lignocaine Spray (Xylocaine Spray)
• goals: topical anaesthesia to increase patient comfort, control hemodynamics and facilitate tracheal intubation via oral or nasal routes.
• Amide local anaesthetic, metabolized by the liver.
• elective nasotracheal intubation: 3-5 cc of 2% lidocaine in an atomiser inhaled into each nares or 4 cc of 4% lidocaine nebulised into the oropharynx; both techniques completely anaesthetise the vocal cords in ~ 5 minutes
• Intravenous route may be effective in blunting the response to laryngoscopy and intubation