Traditionally there are four options for pretreatment for Rapid Sequence Intubation (RSI):
- atropine 20 mcg/kg IV — prevent bradycardia in children
- lignocaine 1.5mg/kg IV — sympatholytic, neuroprotection in head injury; decrease airway reactivity in asthma
- fentanyl 2-3 mcg/kg IV — sympatholytic, neuroprotection in head injury and vascular emergencies (e.g. myocardial ischaemmia, aortic dissection, subarachnoid haemorrhage)
- defasciculating dose of a non-depolarising neuromuscular blocker (e.g. rocuronium 0.1 mg/kg IV or vecuronium 0.01 mg/kg IV) — prevents fasciculations from suxamethonium (e.g. TBI)
Other agents suggested as pretreatment for rapid sequence induction:
- There is little evidence that any of these are beneficial clinically
- They should not be a routine part of clinical practice but may be considered in selected patients by skilled practitioners
References and Links
- Kovacs G, Macquarrie K, Campbell S. Pretreatment in rapid sequence intubation: Indicated or contraindicated? CJEM. 2006 Jul;8(4):243; author reply 243-4. PMID: 17324300.
- Clancy M, Halford S, Walls R, Murphy M. In patients with head injuries who undergo rapid sequence intubation using succinylcholine, does pretreatment with a competitive neuromuscular blocking agent improve outcome? A literature review. Emerg Med J. 2001 Sep;18(5):373-5. PMC1725690.
- Butler J, Jackson R. Best evidence topic report. Lignocaine as a pretreatment to rapid sequence intubation in patients with status asthmaticus. Emerg Med J. 2005 Oct;22(10):732. PMC1726553.
FOAM and web resources
- ACEP Now — Rapid Sequence Intubation Pharmacology (2010)