Читать книгу Ottawa Anesthesia Primer - Patrick Sullivan - Страница 100

A goal-directed patient-oriented approach to the rational use of medications.

Tracheal intubation is frequently performed using a variety of medications. For the student, the rationale behind the choice, dosage, and timing of medications used for tracheal intubation is often obscure. This can be both confusing and daunting for physicians who have limited experience with intubation and are attempting to learn this skill. As a consequence, the temptation is to learn a standard “recipe” and apply it to all patients requiring tracheal intubation. The recipe approach is generally successful in achieving tracheal intubation, but often will fail to meet other important goals specific to the patient.

In formulating a rational plan for tracheal intubation, it is essential to develop specific goals for each patient. The specific goals provide a foundation for the choice of medications used to perform tracheal intubation.

The specific goals may include some or all of the following:

 Amnesia

 Anxiolysis

 Analgesia

 Muscle relaxation

 Hemodynamic stability (avoidance of tachycardia, bradycardia, hypotension, hypertension)

 Minimal change in intra cerebral pressure (ICP)

 Prevention of gastric aspiration