PENTOTHAL

(THIOPENTAL SODIUM)

• SHORT ACTING BARBITUATE
• CNS DEPRESSANT
• ONSET OF ACTION 10-20 SEC
• DURATION OF EFFECT 5-10 MIN
• DOSE: 2-5 MG/KG IVP
• SIGNIFICANT ADVERSE HEMODYNAMIC EFFECTS (SHOULD NOT BE USED WITH HYPOTENSION OR HYPOVOLEMIA 
• IDEAL AGENT IN HEAD INJURY (DECREASES ICP)
• DISADVANTAGES: HYPOTENSION, PORPHYRIA

BREVITAL

(METHOHEXITAL)

• BARBITUATE
• SIMILAR TO PENTOTHAL
• VERY SHORT ACTING
• ONSET OF ACTION LESS THAN ONE MINUTE
• LASTS 5-7 MINUTES
• DOSE: 1-2 MG/KG
• DISADVANTAGES: HYPOTENSION

ETOMIDATE

(AMIDATE)

• NON BARBITUATE HYPNOTIC AGENT
• EXCELLENT SAFETY PROFILE (PREHOSPITAL AND HOSPITAL)
• ONSET OF ACTION IS 10-20 SEC:
• DURATION OF EFFECT 3-5 MIN
• DOSE: 0.2-0.3 MG/KG IV OVER 15-30
• DISADVANTAGE: CORTISAL SUPPRESION

PROPOFOL

(DIPRIVAN)

• EXTREMELY SHORT ACTING INDUCTION SEDATIVE
• HIGHLY LIPID SOLUBLE AND RAPIDLY PENETRATES THE BLOOD-BRAIN BARRIER.
• CAUSES APNEA RAPIDLY, UNSUTABLE FOR RSI, INICATED FOR POST INTUBATION SEDATION.
• ONSET OF ACTION 10-20 SEC
• DURATION OF EFFECT 10-15 MIN
• DOSE. 1-3 MG/KG IV
• DISADVANTAGE: HYPOTENSION, APNEA

• NEUROLEPTIC AGENT
• DISSOCIATIVE DRUG (PT APPEARS AWAKE BUT IS ACTUALLY IN DEEP ANESTHESIA, PT IS AMNESTIC AND UNRESPONSIVE TO PAIN)
• USED AS A GENERAL ANESTHESTIC IN PEDIATRICS AND VETERINARY MEDICINE.
• MAY INCREASE BP,PULSE AND CARDIAC OUTPUT
• INCREASES MYOCARDIAL O2 DEMAND, AND CAN INCREASE ICP
• ONSET OF ACTION IS LESS THAN ONE MINUTE
• DURATION OF EFFECT 10-20 MIN.
• TYPICAL INDUCTION DOSE 1-4 MG/KG IV

MIDAZOLAM

(VERSED)

• BENZODIAZEPINE
• POPULAR AGENT FOR RSI
• LONG ACTING (2-4) TIMES MORE POTENT THAN DIAZEPAM
• POTENT AMNESTIC EFFECTS
• ONSET OF ACTION IS 1-2 MIN
• DURATION OF EFFECT IS 30-60 MIN
• TYPICAL DOSE 0.1-0.3 MG/KG IV. 
• CAN BE GIVEN IM WHEN IMMEDIATE ADMINISTRATION IS NEEDED WITHOUT IV ACCESS.

DIAZEPAM

(VALIUM)

• BENZODIAZEPINE
• HYPOTENSION THAT IS COMMON IN BENZO'S IS NOT AS COMMON WITH DIAZEPAM.
• ONSET OF ACTION IS 2-4 MIN
• DURATION OF EFFECT: 30-90 MIN
• TYPICAL INDUCTION DOSE IS 0.25-0.4 MG/KG IV
• DISADVANTAGES: VARIABLE DOSAGE RANGES

LORAZEPAM

(ATIVAN)

• LONG ACTING BEZODIAZEPINE
• RARELY USED IN RSI SECONDARY TO DELAYED ONSET OF ACTION
• USEFUL IN SEDATION OF INTUBATED PATIENTS
• ONSET OF ACTION IS 1-5 MIN
• TYPICAL INDUCTION DOSE IS 50 MCG/KG IV
• DURATION OF EFFECT IS 1-2 HOURS
• PREFERRED FOR LONG TERM SEDATION

• DISADVANTAGES: PREFERRED FOR LONG TERM SEDATION

PREMEDICATION

• MEDICATION USED TO BLUNT OR ATTENUATE VARIOUS ADVERSE SIDE EFFECTS OF NEUROMUSCULAR BLOCKERS. 

INDUCTION AGENTS

• MEDICATIONS USED FOR SEDATION ,PRIOR TO PARALYSIS, DURING RSI.

NEUROMUSCULAR-BLOCKING

AGENTS

• MEDICATIONS USED TO INDUCE MUSCLE RELAXATION, THUS FACILITATING ENDOTRACHEAL INTUBATION.

LIDOCAINE

• ANTIDYSRHYTHMIC , CARDIO VASCULAR AGENT
• CLASS 1B (RAPID SODIUM CHANNEL BLOCKER, SHORTENS REPOLARIZATION)
• CNS AGENT
• LOCAL ANESTHETIC
• ACTION: SUPRESSES AUTOMATICITY OF ISCHEMIC ECTOPIC FOCI WITHOUT AFFECTING CONDUCTION.  THOUGHT TO RAISE THE VENTRICULAR FIBRILLATION THRESHOLD.
• USED IN RSI AS AN INDUCTION AGENT TO BLUNT ICP.
• CONTRAINDICATIONS: KNOWN HYPERSENSITIVITY, VENTRIULAR ECTOPY IN PRESENCE OF BRADYCARDIA. AND SEVERE CONDUCTION ABNORMALITIES WITHOUT PACEMAKER AVAILABILITY.
• DOSE 1.0-1.5 MG/KG IVP 2-3 MIN PRIOR TO RSI
• DOSE: IV BOLUS 1.0-1.5 MG/KG OVER 3 MIN , REPEAT DOSE IS GIVEN IN 5-15 LATER AT HALF THE INITIAL DOSE. MAX 3MG/KG
• PEDIATRIC DOSE: 0.5-1.0 MG/KG PER BOLUS  WITH MAINT INFUSION OF 20-50 MCG/KG/MIN TITRATED TO EFFECT.

ATROPINE SULFATE

(ATROPINE)

• AUTONOMIC NERVOUS SYSTEM AGENT, ANTICHOLINERGIC (PARASYMPATHOLYTIC) ANTIMUSCARINIC AGENT.
• INHIBITS VAGAL TONE
• PRIMARILY USED TO REMOVE EXCESS PARASYMPATHETIC TONE, AND TO BLUNT VAGAL TONE IN RSI.
• USED IN HOSPICE TO DRY ORAL SECREATIONS
• SIDE EFFECTS: PALPATATIONS, TACHYCARDIA, DRY MOUTH, DILATED PUPIS AND POSSIBLE ANXIETY.
• DOSAGE: FOR SIGNIFICANT CARDOVASCULAR INSTABILITY  0.5-1.0 MG IVP q3-5 MIN (MAX DOSE 3 MG)
• DOSAGE : FOR ORGANOPHOSPHATE POISONING IS 2-3 MG IVP (UNTIL RESOLUTION CHOLINERGIC INFLUENCE IS REMOVED.
• DOSAGE: PEDIATRIC 0.01-0.03 MG/KG IVP
• IF GIVEN TO SLOW OR TWO SMALL OF DOSE CAN CAUSE PARADOXICAL SLOWING OF HEART RATE.

VECURONIUM

(NORCURON)

• AUTONOMIC NERVOUS SYSTEM AGENT, SKELETAL MUSCLE RELAXANT, NONDEPOLARIZING
• ACTIONS: NON DEPOLARIZING NEUROMUSCUCLAR BLOCING AGENT .  COMPETES FOR CHOLINERGIC RECEPTOR SITES AT MOTOR END PLATES RESULTING IN PARALYSIS.
• INDICATIONS:IN RSI TO MINIMIZE FASICULATIONSAND DEPOLARIZING EFFECTS OF SUCCS.  AIRWAY MAINTENANCE AND TO ENHANCE VENTILATORY MGMGT. OF THE INTUBATED PT.  USEFUL IN PT'S WITH KIDNEY DX, PMHX OF ASTHMA AND DIMINISHED CARDIAC RESERVE.
• CONTRAINDICATIONS: NONE IN THE EMERGENCY SETTING OTHER THAT KNOWN HYPERSENSITIVITY.
• DOSEAGES 0.01 MG/KG (DEFASICULATING DOSE),  0.08-0.10 MG/KG IVP q 1-2 HOURS (PARALYZING DOSE),  0.1 MG/KG IVP , CAN REPEAT q 1-2 HOURS (PEDS)

SUCCINYLCHOLINE

(ANECTINE)

• DEPOLARIZING NEURO MUSCULAR BLOCKER, AUTONOMIC NERCOUSE SYSEMT AGENT (SYMPATHOMIMETIC), SKELETAL MUSCLE RELAXANT, DEPOLARIZING
• ACTS IN 60 -90 SEC AND LASTS 3-5 MIN
• CAUSES FASICULATION PROGRESSING TO PARALYSIS, INCLUDING PARALYSIS OF DIAPHRAGM
• DOSAGE 1.0-1.5 MG/KG IV
• PEDS DOSE 1.0-2.0 MG/KG IVP
• PREPARE FOR INTUBATION IMMEDIATLEY AFTER ADMINISTRATION, IF INTUBATION IS UNSUCCESSFUL ASSIST VENTILATION.
• CONTRAINDICTED IN PTS WITH PMHX OF MALIGNANT HYPERTHERMIA, SKELETAL MUSCLE MYOPATHIES , USE CATIOUSLY IN PEDS, PTS WITH BURNS, AND PTS WITH SIGNS OF RHABDOMYOLOSIS.

RHABDOMYOLYSIS

• Rhabdomyolysis is the breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream. Myoglobin is harmful to the kidney and often causes kidney damage. port wine colored urine.  CONSIDER INCREASED FLUID ADMINISTRATION UNTIL URINE OUTPUT BECOMES GROSSLY CLEAR.  MONITOR PH LEVELS