RSI drugs Flashcards
What are the commonly used induction agents for RSI?
-etomidate
-propofol
-ketamine
-midazolam
What are the commonly used paralytics for RSI?
-succinylcholine
-rocuronium
-vercuronium
-pancuronium
What type of drug is etomidate?
-imidazole derivative
-activates GABA receptors
What type of drug is propofol?
-alkylphenol derivative
-potentiates GABA receptors
What type of drug is ketamine?
-phencyclidine derivative
-non-competitive antagonist of NMDA
What type of drug is midazolam?
benzodiazepine
What type of drug is succinylcholine?
depolarizing agent
What type of drug is rocuronium?
non-depolarizing agent
What type of drug is vecuronium?
non-depolarizing agent
What type of drug is pancuronium?
non-depolarizing agent
What are the pros of using etomidate?
-no hypotension
-no increase in ICP
-short onset of action and half-life
-preferred in trauma
What are the pros of using propofol?
-may be neuroprotective
-quick onset and short duration
What are the pros of using propofol?
-may be neuroprotective by reducing intracranial pressure
-has anticonvulsive and anti-emetic properties
-quick onset and short duration
-can be used as an infusion
What are the pros of using ketamine?
-provides sedation and analgesia
-preserves respiratory drive
-can increase MAP
-has bronchodilator properties that make it good in severe asthma
What are the pros of using midazolam?
-good for providing amnesia
What are the pros of using midazolam?
-good for providing amnesia
-anticonvulsant
What are the pros of using succinylcholine?
-best choice, if one of its many contraindications isn’t a problem
What are the pros of using succinylcholine?
-best choice, if one of its many contraindications isn’t a problem
What are the pros of using rocuronium?
similar to SCh, but without all the contraindications
What are the pros of using rocuronium?
similar to SCh, but without all the contraindications
What are the adverse effects of etomidate?
-transient adrenal suppression
-controversial concerns in sepsis and trauma
-transient myoclonus
What are the adverse effects of propofol?
-myocardial depression
-peripheral vasodilation –> decreased MAP
-needs to be avoided in hypovolemic pt
What are the adverse effects of midazolam?
-drops MAP 10-25% in healthy pts
-does not provide analgesia
What are the adverse effects of ketamine?
-may increase ICP (controversial)
What are the adverse effects of succinylcholine?
-increases ICP
-in peds causes bradycardia (get the atropine ready)
What are the contraindications to using succinylcholine?
-hyperkalemia
-h/o malignant hyperthermia
-muscular dystrophy
-rhabdomyolysis
-burns >72hr old
What are the adverse effects of rocuronium?
-long acting so if a difficult airway be careful because the pt will be paralyzed and unable to breath on their own
What is the dosing for rocuronium?
1mg/kg
What is the dosing for succinylcholine?
1.5-2mg/kg
What is the dosing for midazolam?
0.-0.3mg/kg
What is the dosing for midazolam?
0.1-0.3mg/kg
What is the dosing for ketamine?
1-2mg/kg
What is the dosing for propofol?
1.5-3mg/kg
What is the dosing for etomidate?
0.3mg/kg
What is the onset and duration of etomidate?
-15-45s
-3-12min
What is the onset and duration of propofol?
-15-45s
-5-10min
What is the onset and duration of ketamine?
-45-60s
-10-20min
What is the onset and duration of midazolam?
-30-60s
-15-30min
What is the onset and duration of succinylcholine?
-45-60s
-6-10min
What is the onset and duration of rocuronium?
-45-60s
-45-80min
What is the onset and duration of vecuronium?
-1.5-3min
-45-90min
What are the pros of using succinylcholine?
-best choice, if one of its many contraindications isn’t a problem
What are the adverse effects of ketamine?
-may increase ICP (controversial)
What is the onset and duration of pancuronium?
-3-5min
-60-90min
What are the adverse effects of propofol?
-myocardial depression
-peripheral vasodilation –> decreased MAP
-needs to be avoided in hypovolemic pt
What is the onset and duration of vecuronium?
-1.5-3min
-45-90min
What are the adverse effects of propofol?
-myocardial depression
-peripheral vasodilation –> decreased MAP
-needs to be avoided in hypovolemic pt
What are the adverse effects of ketamine?
-may increase ICP (controversial)
What medications can cause a prolonged effect of nondepolarizing agents?
-aminoglycosides
-clindamycin
What disorders/conditions can cause a prolonged effect of nondepolarizing agents?
-hypermagnesemia
-myasthenia gravis
-hypothermia
Which nondepolarizing agents have a metabolite that can cross the blood brain barrier and cause seizures?
-cistatracurium and atracurium
-metabolized to laudanosine
How are cisatracurium and atracurium metablized?
-Hofmann elimination
-so can use in liver failure
How are rocuronium, vecuronium, pancuronium metabolized?
-metabolized in the liver
-eliminated by the kidney
