Pediatric emergency medicine trisk 0176 0176
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (100.43 KB, 1 trang )
TABLE 8.4
NEUROMUSCULAR-BLOCKING AGENTS (PARALYTICS)
Medication
Dose
Succinylcholine
Rocuronium
Vecuronium
Cisatracurium
1–2 mg/kg
0.6–1.2 mg/kg
0.1–0.2 mg/kg
0.1–0.2 mg/kg
Nondepolarizing NMBAs do not cause fasciculations or associated side effects.
Rocuronium is the most frequently used drug from this class for RSI. When used
at higher dose (1.2 mg/kg), it has been shown to achieve equivalent intubating
conditions in the same time frame as succinylcholine. However, it has a duration
of 30 to 45 minutes or longer.
Rocuronium’s longer duration is often cited as a disadvantage. However, newer
considerations make the longer duration an advantage over succinylcholine in
difficult intubations during which the duration of succinylcholine has elapsed,
resulting with the return of muscle tone, movement, and risk of active
regurgitation/aspiration. With rocuronium, paralysis is maintained and the patient
can be bag-mask ventilated for another intubation attempt. Additionally,
maintenance of the paralysis is preferable for imaging, ventilator management,
vascular access, etc. The need for the early reversal of rocuronium paralysis is
occasionally beneficial, either to allow return of spontaneous respiration if
intubation is not successful, or to allow return of a neurologic examination.
Reversal can be accomplished with sugammadex.
NMBAs with longer durations require maintenance of sedation to avoid
conscious paralysis. This can occur since neuromuscularly blocked patients do
not prompt the clinician for the need for sedation. Therefore, once TI is secured,
the clinician must take the initiative to maintain appropriate sedation.
Adjunctive Agents
Atropine
Atropine reduces the risk of bradycardia which can result from laryngoscopy or
succinylcholine use, a physiologic phenomenon more commonly observed in
infants and younger children. Atropine reduces oral secretions if ketamine is to be
given, although the antisialogogue activity may take 15 to 20 minutes to take
effect.
