Читать книгу Emergency Medical Services - Группа авторов - Страница 106

A wide range of sedative/induction and neuromuscular blocking agents exist. The most popular sedative/induction agent for RSI is etomidate. Most clinicians favor this agent because of its minimal effect upon blood pressure, heart rate, and intracerebral pressure. The typical induction dose for etomidate is 0.3 mg/kg intravenously (20 mg in a typical 70‐kg patient). Some studies have raised concern regarding the clinical consequences of adrenal suppression resulting from etomidate administration [76, 77]. Limited data describe the link between etomidate’s adrenocortical suppression and patient outcomes [77].

Another commonly used agent for sedation/induction is midazolam 0.1 mg/kg. However, because midazolam and other benzodiazepines may cause clinically significant hypotension, and because many prehospital patients requiring RSI have significant hemodynamic compromise, many EMS physicians prefer not to use these agents for prehospital RSI.

While not truly a sedative agent, ketamine has emerged as another potential agent for facilitating RSI. Ketamine is a dissociative agent. In the absence of neuromuscular blockade use, ketamine maintains airway reflexes. Ketamine is also not associated with significant hypotension. Side effects of ketamine include increased secretions and potential increase of intracranial pressure. While the latter could be harmful in patients with traumatic brain injury, the association of ketamine use with outcomes in these patients is unclear. Ketamine is typically dosed at 1 to 2 mg/kg intravenously, or 2 to 4 mg/kg if given intramuscularly.