Induction agents.docx

7/24/2019 Induction agents.docx

1/17

Induction agents

Etomidate

General use Etomidate is an imidazole-derived, sedative-hypnotic agent that is frequentlyused for rapid sequence intubation (RI!" Etomidate acts directly on the gamma amino butyricacid (G#$#! receptor comple%, bloc&ing neuroe%citation and producing anesthesia" Etomidate is

given by intravenous push in a dose of '" mg)&g, *ith a time to effect of + to seconds and a

duration of action of to +. minutes /+0" It is the most hemodynamically neutral of the sedativeagents used for RI, and does not stimulate histamine release /+-.+0"

Etomidateprovides no analgesic effect, so it does not blunt the no%ious stimulation of the upper

air*ay during laryngoscopy and intubation" 1or patients in *hom this is a concern (eg, patients

*ith cardiovascular disease or elevated intracranial pressure!, an opioid analgesic, such asfentanyl,is often given during the pretreatment phase of RI /..0"

2he hemodynamic stability associated *ith etomidate ma&es it the drug of choice for the

intubation of hypotensive patients, as *ell as an attractive option for patients *ith intracranial

pathology, *hen hypotension must be avoided /+-+3,.+0" Etomidate causes a mild increase inair*ay resistance, but less so than thiopental, and may be used in patients *ith bronchospasm

/.0"

4oncerns *ith etomidate include adrenal suppression (discussed belo*!, myoclonus, and

evidence of regional cerebral e%citation (determined by electroencephalogram! after intubation/+5,.,.0" 6yoclonus has been misidentified as seizure activity, leading to incorrect

recommendations that etomidate be avoided in patients *ith seizure disorders" 6yoclonus during

RI is brief and minimal, because of the concomitant administration of a paralytic agent, and ofno clinical significance" Etomidate decreases cerebral blood flo* and cerebral metabolic o%ygen

demand, *hile preserving cerebral perfusion pressure /.+0" 7ostintubation sedation *ithpropofol

or benzodiazepines helps to prevent neuroe%citation"

#drenocortical suppression 2he ma8or controversy surrounding etomidate stems from thereversible adrenocortical suppression associated *ith its use /.9-.30" Etomidate is a reversible

inhibitor of ++-beta-hydro%ylase, *hich converts ++-deo%ycortisol to cortisol (figure +!" (ee

:#drenal steroid biosynthesis:"!

# single dose of etomidatecauses a measurable decrease in the level of circulating cortisol that

occurs in response to the administration of e%ogenous #42;, although cortisol levels do not fallbelo* the normal physiologic range" 2his effect does not persist beyond +. to . hours /.30"

ome researchers have raised concerns regarding the safety of etomidatein the setting of adrenal

insufficiency related to sepsis /.


2/17

among patients randomly assigned to induction *ith etomidate or an alternative induction agent

/+0"

# multicenter randomized trial of critically ill patients requiring emergent intubation found nosignificant difference in organ failure score, .5 day mortality, or intubating conditions bet*een

patients given etomidatefor induction and those given &etamine/.0" =o serious, drug-relatedadverse events *ere reported for either medication" #lthough adrenal insufficiency occurred at ahigher rate in the etomidate group (59 percent!, it also developed in appro%imately 5 percent of

patients receiving &etamine"

# systematic revie* of .' studies in *hich etomidate*as given in a bolus dose as part of

induction for tracheal intubation found that etomidate does not have a significant effect uponmortality /0" >eclines in serum cortisol concentrations *ere more prevalent among etomidate

recipients than those *ho did not receive etomidate in the large ma8ority of studies, but did not

persist beyond five hours" 2he authors note that no individual study included in the revie* *assufficiently po*ered to detect differences in mortality or resource utilization"

?ess rigorous individual studies, and fla*ed revie*s based upon such studies /0, have reported

mi%ed results that do not 8ustify recommendations to avoid using etomidate for induction in

patients *ith sepsis"

# small observational study of children *ith meningococcal sepsis reported a correlation

bet*een the use ofetomidatefor RI and lo* cortisol levels, *hich increased the ris& of

death /.


3/17

etomidateas part of RI have reported no increase in mortality, vasopressor use, or I4B

length of stay /


4/17

suggestetomidateor &etaminebecause of their superior hemodynamic profiles" (ee FEtomidateF

above and FHetamineFbelo*"!

6idazolamis frequently underdosed (common dose '"' mg)&g! *hen used for emergencydepartment RI /.0" 6idazolam is often used for procedural sedation in much smaller doses

than are required for RI, *hich may contribute to underdosing /+0"

6idazolamcan be used as an infusion for long-term sedation" >oses of '"' to '" mg)&g per

hour I have been sho*n to be safe and effective in critically ill neonates and children / ,0,including neonates undergoing e%tracorporeal membrane o%ygenation /0" >osing in intubated

adults should be titrated to an endpoint of adequate sedation, preferably using a sedation scale"

?orazepamand diazepamare benzodiazepines used frequently for long-term sedation follo*ing

intubation, but are not recommended for RI" $oth require propylene glycol as a diluent, andthere are reports of propylene glycol to%icity associated *ith long-term infusions / 90" (ee

:edative-analgesic medications in critically ill patientsC 7roperties, dosage regimens, and

adverse effects:, section on F$enzodiazepinesF"!

$arbiturates

2he ultrashort-acting barbiturates interact *ith the barbiturate component of the G#$# receptor

comple%, causing profound amnesia and sedation" 2hiopental sodium is the barbiturate most

commonly used for rapid sequence intubation (RI!" 2he induction dose is to mg)&g I, *itha time to effect of less than ' seconds, and a duration of action of to +' minutes /


5/17

decrease in phagocytosis /+0" 2hese immunosuppressive effects ma&e barbiturates poor

induction agents in the setting of sepsis, and *e do not recommend their use"

Hetamine

General use Hetamineis a dissociative anesthetic agent, structurally similar to phencyclidine(747!" It is unique among sedative agents in that it provides analgesia along *ith its amnestic

and sedative effects" Hetamine is given intravenously in doses of + to . mg)&g, *ith a time to

effect of to 9' seconds, and a duration of action of +' to .' minutes"

Hetamineacts at many receptors causing a range of effects" It is thought to stimulate the =-

methyl->-aspartate receptor at the G#$# receptor comple%, causing neuroinhibition and

anesthesia" It e%cites opioid receptors *ithin the insular corte%, putamen, and thalamus,

producing analgesia /9,


6/17

&etamine, they *ere generally pleasant, and the frequency of reemergence phenomena and

delirium *as mar&edly reduced by concomitant use of a benzodiazepine /90"

Elevated intracranial pressure 4ontroversy persists regarding the use of &etaminein patients*ith a head in8ury due to concerns about elevating intracranial pressure (I47!" Apponents

emphasize that &etamine can cause a rise in I47 through sympathetic stimulation, potentiallye%acerbating the condition of such patients /9,990" ;o*ever, *hen &etamine is used *ith aG#$# agonist, this rise in I47 may not occur / 9


7/17

7ropofol reduces air*ay resistance and can be a useful induction agent for patients *ith

bronchospasm undergoing RI /.,


8/17

epilepticus *hen the patient manifests hemodynamic compromise" e suggest &etaminenot be

used because of its stimulant effects"

Reactive air*ay disease 1or hemodynamically stable patients *ith severe bronchospasmrequiring intubation, *e suggest &etamine or propofolbe used for induction, because of their

bronchodilatory properties /.,9'0" Etomidate and midazolam are acceptable alternatives" Inhypotensive patients, *e prefer &etamine or etomidate" =one of these agents causes histaminerelease, unli&e thiopental,*hich is not recommended for this reason"

4ardiovascular disease e suggest etomidate for induction of the patient *ith significant

cardiovascular disease requiring RI /+


9/17

Hetamineis gaining popularity in this circumstance because it allo*s the patient to maintain

respiratory drive *hile providing analgesia, amnesia, and sedation /ifferent clinical scenarios lend themselves to the use of certain sedatives *hen RI is needed

(table +!" e suggest the follo*ing induction agents be used in the specific clinical

circumstances described belo* (Grade .4!C

In the patient *ith a head in8ury or potentially elevated intracranial pressure (I47!,adequate cerebral perfusion pressure must be maintained to prevent secondary brain

in8ury" e suggest etomidatefor induction of these patients" 1or hypotensive patients,

etomidate or &etamine may be used" Hetamine should be avoided in patients *ithhypertension or if elevated I47 is caused by spontaneous cerebral hemorrhage" (ee

F;ead in8ury or stro&eFabove and FEtomidateFabove and FHetamineFabove"!

1or the rapid sequence intubation (RI! of patients in status epilepticus, *e suggest

midazolam orthiopentalbe used for induction" Reduced doses should be used in the

unusual circumstance of seizure *ith hypotension" Etomidatemay be used *hen thepatient manifests hemodynamic compromise" e suggest &etamineNOTbe used because

of its stimulant effects" (ee Ftatus epilepticusFabove"!

1or the hemodynamically stable patient *ith severe bronchospasm requiring

intubation, *e suggest induction *ith &etamineor propofol" Etomidateormidazolamisan acceptable alternative" In hemodynamically unstable patients *ith severe

bronchospasm, *e suggest &etamine or etomidate" e suggest that thiopentalNOT be

used in these patients because it provo&es histamine release and can induce or e%acerbatebronchospasm" (ee FReactive air*ay diseaseFabove"!

1or induction of the patient *ith cardiovascular compromiserequiring RI, *e suggest

etomidatebecause of the hemodynamic stability it provides" (ee F4ardiovascular diseaseF

above and FEtomidateFabove"!

1or induction of the patient in shockrequiring RI, *e suggest &etamineor etomidate" If

etomidate is used in a patient *ith sepsis and hypotension refractory to treatment *ith

fluid resuscitation and a vasopressor, *e suggest that a single dose of glucocorticoid (eg,

hydrocortisone +'' mg I! be given" (ee Fhoc&F above and FEtomidateF above and

FHetamineFabove"!
http://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/57,63,67,95http://www.uptodate.com/contents/rapid-sequence-intubation-in-adults?source=see_linkhttp://www.uptodate.com/contents/rapid-sequence-intubation-rsi-in-children?source=see_linkhttp://www.uptodate.com/contents/rapid-sequence-intubation-rsi-in-children?source=see_linkhttp://www.uptodate.com/content-not-availablehttp://www.uptodate.com/contents/grade/6?title=Grade%202C&topicKey=EM/271http://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H15http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H5http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H5http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H10http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H10http://www.uptodate.com/contents/midazolam-drug-information?source=see_linkhttp://www.uptodate.com/contents/midazolam-drug-information?source=see_linkhttp://www.uptodate.com/contents/thiopental-drug-information?source=see_linkhttp://www.uptodate.com/contents/thiopental-drug-information?source=see_linkhttp://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H16http://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/propofol-drug-information?source=see_linkhttp://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/midazolam-drug-information?source=see_linkhttp://www.uptodate.com/contents/midazolam-drug-information?source=see_linkhttp://www.uptodate.com/contents/thiopental-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H17http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H17http://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H18http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H5http://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/hydrocortisone-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H19http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H5http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H10http://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/57,63,67,95http://www.uptodate.com/contents/rapid-sequence-intubation-in-adults?source=see_linkhttp://www.uptodate.com/contents/rapid-sequence-intubation-rsi-in-children?source=see_linkhttp://www.uptodate.com/content-not-availablehttp://www.uptodate.com/contents/grade/6?title=Grade%202C&topicKey=EM/271http://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H15http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H5http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H10http://www.uptodate.com/contents/midazolam-drug-information?source=see_linkhttp://www.uptodate.com/contents/thiopental-drug-information?source=see_linkhttp://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H16http://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/propofol-drug-information?source=see_linkhttp://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/midazolam-drug-information?source=see_linkhttp://www.uptodate.com/contents/thiopental-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H17http://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H18http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H5http://www.uptodate.com/contents/ketamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/etomidate-drug-information?source=see_linkhttp://www.uptodate.com/contents/hydrocortisone-drug-information?source=see_linkhttp://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H19http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H5http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults#H10


10/17

1or induction of most patients *ith conditions precluding the use of paralytics in *hom

an :a*a&e loo&: is necessary for intubation, *e suggest &etamine" Hetamine may not beappropriate *hen these patients have cardiovascular disease or hypertension" (ee

F4onditions precluding use of a paralyticFabove andFHetamineFabove"!

Bse of Bp2o>ate is sub8ect to theubscription and ?icense #greement"

REFERENCES

+" ?i L, 6urphy-?avoie ;, $ugas 4, et al" 4omplications of emergency intubation *ith and

*ithout paralysis" #m L Emerg 6ed +333 +


11/17

+." El-Arbany 6I, afai K, Loseph =L, alem 6R" >oes the choice of intravenous induction

drug affect intubation conditions after a fast-onset neuromuscular bloc&erM L 4lin #nesth.'' +C3"

+" &inner ;L, $is*as #, 6aha8an R7" Evaluation of intubating conditions *ith rocuronium

and either propofol or etomidate for rapid sequence induction" #naesthesia +335 C" Intubating conditions and hemodynamic effects ofetomidate for rapid sequence intubation in the emergency departmentC an observational

cohort study" #cad Emerg 6ed .''9 +C


12/17

." Reddy R, 6oorthy , >ierdorf 1, et al" E%citatory effects and

electroencephalographic correlation of etomidate, thiopental, methohe%ital, and propofol"#nesth #nalg +33 ?, et al" #cute secondary adrenal insufficiency after

traumatic brain in8uryC a prospective study" 4rit 4are 6ed .'' C.5"

.


13/17

5" 6c7hee ?4, $ada*i A, 1raser G?, et al" ingle-dose etomidate is not associated *ith

increased mortality in I4B patients *ith sepsisC analysis of a large electronic I4Bdatabase" 4rit 4are 6ed .'+ +Cupuis 4, 2rouve-$uisson 2, et al" 4orticosteroid after etomidate in critically

ill patientsC a randomized controlled trial" 4rit 4are 6ed .'+. 'C.3"

'" $lumer L?" 4linical pharmacology of midazolam in infants and children" 4lin

7harmaco&inet +335 C, a&les L4, et al" Bnderdosing of midazolam in emergency

endotracheal intubation" #cad Emerg 6ed .'' +'C.3"

" de ildt =, de ;oog 6, in&s ##, et al" 7opulation pharmaco&inetics and metabolismof midazolam in pediatric intensive care patients" 4rit 4are 6ed .'' +C+3."

" 2obias L>, $er&enbosch L" edation during mechanical ventilation in infants and

childrenC de%medetomidine versus midazolam" outh 6ed L .'' 3?, ;ossain , Hrol 6, et al" 7redictors of hypotension after induction of general

anesthesia" #nesth #nalg .'' +'+C9.."

3" ;irota H, Ahtomo =, ;ashimoto K, et al" Effects of thiopental on air*ay calibre in dogsCdirect visualization method using a superfine fibreoptic bronchoscope" $r L #naesth

+335 5+C.'"

'" Heel 6, 6ica ?, tover L, et al" 2hiopental-induced apoptosis in lymphocytes is

independent of 4>3 activation" #nesthesiology .'' +'C


14/17

." ato 6, 2ana&a , uzu&i H, et al" 4omplications associated *ith barbiturate therapy"

Resuscitation +353 +


15/17

9" Grace R1" 2he effect of variable-dose diazepam on dreaming and emergence phenomena

in '' cases of &etamine-fentanyl anaesthesia" #naesthesia .'' 5C3'"

9" yte R, hapiro ;6, 2urner 7, ;arris #$" Hetamine-induced intracranial hypertension"#nesthesiology +3annemiller 1L, >ean >" Intracranial cerebrospinal fluid pressure in man

during &etamine anesthesia" #nesth #nalg +3urieu% 6E" Revising a dogmaC &etamine for patients *ith neurologicalin8uryM #nesth #nalg .'' +'+C."

95" #lbanUse L, #rnaud , Rey 6, et al" Hetamine decreases intracranial pressure and

electroencephalographic activity in traumatic brain in8ury patients during propofol

sedation" #nesthesiology +33


16/17

, et al" evoflurane but not propofol preserves myocardial

function during minimally invasive direct coronary artery bypass surgery" #nesth #nalg.'' +''C9+'"

5'" Ebert 2L" ympathetic and hemodynamic effects of moderate and deep sedation *ith

propofol in humans" #nesthesiology .'' +'C.'"

5+" 6asuda 2, 2omiyama K, Hitahata ;, et al" 7ropofol inhibits volume-sensitive chloridechannels in human coronary artery smooth muscle cells" #nesth #nalg .'' 3, $oo&er 7>, $uc&ley >G" 2he effects of propofol and sevoflurane on the J2

interval and transmural dispersion of repolarization in children" #nesth #nalg .''

+''C, Ernst ##, et al" 7rotocol for rapid sequence intubation inpediatric patients -- a four-year study" 6ed ci 6onit .''. 5C4R..3"

53" onday 4L, #%elband L, Lacoby L, et al" 2hiopental vs" etomidate for rapid sequence

intubation in aeromedicine" 7rehosp >isaster 6ed .'' .'C."
http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/77http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/77http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/78http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/78http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/78http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/79http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/79http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/79http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/80http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/80http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/81http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/81http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/82http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/82http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/82http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/83http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/83http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/83http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/84http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/84http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/85http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/85http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/85http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/86http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/86http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/87http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/87http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/88http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/88http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/89http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/89http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/77http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/77http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/78http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/78http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/78http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/79http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/79http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/79http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/80http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/80http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/81http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/81http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/82http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/82http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/82http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/83http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/83http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/83http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/84http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/84http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/85http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/85http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/85http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/86http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/86http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/87http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/87http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/88http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/88http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/89http://www.uptodate.com/contents/sedation-or-induction-agents-for-rapid-sequence-intubation-in-adults/abstract/89


17/17

3'" 4hoi K1, ong 2, ?au 44" 6idazolam is more li&ely to cause hypotension than

etomidate in emergency department rapid sequence intubation" Emerg 6ed L .''.+C, et al" ;emodynamic responses to etomidate on

induction of anesthesia in pediatric patients" #nesth #nalg .'' +'+C9"

3." Hir&egaard-=ielsen ;, 4ald*ell LE, $erry 7>" Rapid tracheal intubation *ith

rocuroniumC a probability approach to determining dose" #nesthesiology +333 3+C++"

3"=aguib 6, amar&andi #, Riad , #lharby " Aptimal dose of succinylcholine

revisited" #nesthesiology .'' 33C+'"

3" >urmus 6, Ender G, Hadir $#, et al" Remifentanil *ith thiopental for tracheal intubation

*ithout muscle rela%ants" #nesth #nalg .'' 39C+9"

3" $ah& L;, ung L, Lang IL" # comparison of &etamine and lidocaine spray *ith propofolfor the insertion of laryngeal mas& air*ay in childrenC a double-blinded randomized trial"

#nesth #nalg .''. 3C+59"

39" $air #E, 1ilbin 6R, Hul&arni RG, alls R6" 2he failed intubation attempt in the

emergency departmentC analysis of prevalence, rescue techniques, and personnel" L Emerg6ed .''. .C++"

3

Induction agents.docx

Documents