Tracheal Intubation

Question 1

Pretreatment agents include:

Answer 1

Lidocaine 1.5mg/kg
Fentanyl 3mcg/kg

Question 2

Benefits of pre-treatment agents:

Answer 2

MINIMIZES increases in HR, BP and ICP

Question 3

Etomidate dose, onset of action and duration of action

Answer 3

DOSE: 0.3-0.5mg/kg
ONSET OF ACTION: less than 1 min
DURATION: 10-20 mins

Question 4

ADVANTAGES of ETOMIDATE

Answer 4

1. Short duration of action
2. Protection from myocardial and cerebral ischemia
3. Little hemodynamic depression

Question 5

DISADVANTAGES of ETOMIDATE

Answer 5

1. MINIMAL histamine release
2. Not an analgesic
3. It does not blunt the sympathetic response to intubation

Question 6

PROPOFOL dose, onset and duration of action

Answer 6

Dose: 0.5-1.5mg/kg
Onset: 20-40s
Duration: 8-15mins

Question 7

ADVANTAGES of Propofol:

Answer 7

1. More rapid onset of action and shorter duration of action than etomidate
2. Anticonvulsant and antiemetic properties
3. Lowers ICP WITHOUT histamine release

Question 8

DISADVANTAGE of Propofol

Answer 8

HYPOTENSION

Question 9

KETAMINE dose, onset and duration

Answer 9

DOSE: 1-2mg/kg
ONSET: 1 min
DURATION: 10-20min

Question 10

Advantages of Ketamine:

Answer 10

1. Dissociative agent that PROVIDES analgesia and amnesia
2. Preserves the respiratory drive
3. Increases BP and HR through CATECHOLAMINE release
4. Good for asthmatics because it causes BRONCHODILATION
5. Can be used for patients with head injury and hypotension
6. Cerebroprotective effects

Question 11

Patient with acute cardiac ischemia, will you give Ketamine?

Answer 11

No

Ketamine causes tachycardia and hypertension (due to catecholamine increase)

Question 12

Succinylcholine, depolarizing vs nondepolarizing, dose, onset and duration:

Answer 12

Depolarizing agent
DOSE: 1.5mg/kg
ONSET: 45-60 sec
DURATION: 5-9 mins

Question 13

Effect of succinylcholine with serum potassium:

Answer 13

Transiently increase K by an average of 0.5 meq/L

Question 14

Contraindications to Succinylcholine

Answer 14

Preexisting hyperkalemia
Burns >5 d old
Denervation injury >5 d old
Significant crush injuries >5 d old
Severe infection >5 d old
Myesthenia Gravis

Question 15

Usually, succinylcholine can cause malignant hyperthermia. What is the treatment of choice for this complication?

Answer 15

Dantrolene IV (2.5mg/kg)

Question 16

Rocuronium dose, onset and duration

Answer 16

DOSE: 1mg/kg
Onset: 1-3 mins
Duration: 30-45 mins

Question 17

Disadvantage of rocuronium

Answer 17

Can cause tachycardia

Question 18

Vecuronium bromide dose, onset and duration of action

Answer 18

DOSE: 0.08-0.15 mg/kg
Onset: 2-4 min
Duration: 25-40 min

Question 19

Advantages of Vecuronium

Answer 19

1. No cardiac effects
2. Hypersensitivity reactions are rare

Question 20

Disadvantage of Vecuronium

Answer 20

Hypotension thru sympathetic ganglia block and less venous return from altered or absent muscle tone and positive-pressure ventilation

Question 21

This is a reversal agent that reverses blockade from rocuronium and vecuronium. Include the dose

Answer 21

Sugammadex 2-4mg/kg