Intubation Drugs
Pre-treatment
| Medication | Dose |
|---|---|
| Lidocaine (Elevated ICP, give 3 minutes before RSI) | 1.5 mg/kg IV over 1m |
| Lidocaine (Before Propofol) | 0.5 mg/kg 1 minute before, with tourniquet |
| Glycopyrrolate (To dry mucosal membranes) | 0.005 mg/kg (Typically ~0.4 mg) |
Rapid Sequence Intubation
Sedatives
| Medication | Dose | |
|---|---|---|
| Etomidate | 0.3 mg/kg IV | Onset in 30 seconds |
| Propofol | 1-2 mg/kg IV | |
| Ketamine (IV) | 1-2 mg/kg | Indicated in Asthma/Airway Disease Intubation |
| Ketamine (IM) | 3.0 mg/kg | Used when no IV Access is available |
| Midazolam | 0.3 mg/kg |
Paralytics
| Medication | Dose | Onset |
|---|---|---|
| Rocuronium | 1.2 mg/kg IV | 1 minute |
| Succinylcholine IV | 1.5 mg/kg IV | 1 minute |
| Succinylcholine IM | 3-4 mg/kg IM (Max 150mg) | 1-4 minutes |
| Vecuronium | 0.1 mg/kg IV | 2 minute (duration 1h) |
| Vecuronium | 0.2 mg/kg IV | 1 minute (“Double dose” has faster onset, but longer duration ~2h) |
Reversal Agents
| Medication | Dose | Reverses which paralytics? |
|---|---|---|
| Sugammadex | 2-4 mg/kg | Rocuronium, Vecuronium |
| 16 mg/kg | Can’t Intubate, Can’t Ventilate | |
| Neostigmine + Glycopyrrolate1 | 50 mcg/kg (N) + 10 mcg/kg (G) | Rocuronium, Vecuronium |
Footnotes
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Neostigmine is an Intermediate speed of onset Acetylcholinesterase inhibitor that does not cross the BBB that acts to increase Acetylcholine in the Neuromuscular Junction; this can overcome competitive inhibition by rocuronium. Always give Neostigmine with Glycopyrrolate (Anticholinergic) because AChEi can have parasympathatic side effects (Bradycardia, GI stimulation, Bronchospasm). Dose Glycopyrrolate at 1/5 the dose of Neostigmine. ↩