RSI Meds Flashcards
Classification of Etomidate
Anesthetic, Non-Barbiturate, Sedative/ hypnotic
Etomidate Mechanism of Action
- Non-Barbiturate that prolongs the effect of GABA
- Depresses the activity and reactivity of the brain stem reticular system
Etomidate Indications
- General Anesthesia
- Premedication for RSI
- Adjuncts for low potency anesthetics (Nitronox)
Rocuronium Classification
Non-Depolarizing Neuromuscular Blockade
Rocuronium MOA
Prevents acetylcholine from binding to receptors on the motor end plate, thus blocking action potential transmission and muscle contraction
Rocuronium Indications
RSI or Pharmacologically assisted intubation
Succinylcholine Classification
Paralytic, depolarizing neuromuscular blocking agent
Succinylcholine MOA
Prevents Neuromuscular transmission by blocking the effect of acetylcholine at the myoneural junction
Succinylcholine Indications
RSI
Vecuronium Classification
Non Depolarizing skeletal muscle relaxant
VECURONIUM TRADE NAME
Norcuron
Vercuronium MOA
Inhibits neuromuscular transmission by competitively binding with acetylcholine motor endplate receptors resulting in muscle paralysis
Vecuronium Indications
Pharmacologically assisted endotracheal intubation or RSI
Fentanyl Trade Name
SUBLIMAZE
Fentanyl Classification
Narcotic Analgesic
Fentanyl MOA
Provides Analgesic and sedation by acting on the opiate receptors in the brain, blocking sensation of pain
Fentanyl Indications
- Sedation during RSI
- moderate to severe pain
Fentanyl Contraindications
- PT’s who have received MAO inhibitors in the last 14 days
- myasthenia gravis
Fentanyl Dose
25-100 mcg or IM (over 2-3 minutes)
Peds: 2.0 mcg/kg slow IVP or IM
Fentanyl Routes
IV IO IM TD
Fentanyl Adverse Effects
- Cardiovascular: hypotension, bradycardia, circulatory depression, cardiac arrest
- Neurological: Sedation, euphoria, dizziness, diaphoresis, seizures with high doses, delirium,
- Respiratory: Respiratoy Depression, Arrest , bronchi constriction, laryngospasm
- G.I.: Nausea/ vomiting , constipation
Fentanyl Precautions
Use with caution in head injuries, suspected or known increased ICP, the elderly, debilitated or immunocompromised pt’s, COPD or other respiratory problems and those with kidney or liver dysfunction. Use caution in pregnancy and in children <2 years old due to respiratory paralysis side effects
Fentanyl Onset and Duration or Action
Onset is immediate, peak effect in 3-5 minutes IV, 5-15 IM, duration is 30-60 minutes (or hours with transdermal patch)
Fentanyl interactions
Alcohol and other CNS depressants potentiate effects or fentanyl; MAO inhibitors May precipitate hypertensive crisis
Flumazenil Classification
Benzodiazepine Antagonist
Flumazenil MOA
Competes with Benzodiazepines at the binding site
Flumazenil Indications
- Benzodiazepine overdose
- reversal of sedation in RSI
