critical care medicine
Drugs to Aid Intubation
Sedation and analgesia for intubation
Laryngoscopy and intubation are uncomfortable; in conscious patients, a short-acting IV drug with sedative or combined sedative and analgesic properties is mandatory. Etomidate0.3 mg/kg IV, a nonbarbiturate hypnotic, may be the preferred drug. Fentanyl5 mcg/kg IV (2 to 5 mcg/kg in children) also works well and causes no cardiovascular depression. NOTE: This dose is higher than the analgesic dose and needs to be reduced if used in combination with a sedative-hypnotic, eg,propofoloretomidate.Fentanylis an opioid and thus has analgesic as well as sedative properties. However, at higher doses, chest wall rigidity may occur. Ketamine1 to 2 mg/kg IV is a dissociative anesthetic with cardiostimulatory properties. It is generally safe but may cause hallucinations or bizarre behavior on awakening. These adverse effects can be managed with low doses of prophylactic benzodiazepines. Propofol, a sedative and amnesic, is commonly used in induction at doses of 1.5 to 3 mg/kg IV but can cause cardiovascular depression leading to hypotension. Thiopental 3 to 4 mg/kg IV andmethohexital1 to 2 mg/kg IV tend to cause hypotension and are used less often. 