Acute Care 5: Rapid Sequence Intubation Medications
Sedation for Rapid Sequence Intubation
| Agent/Class | Dose | Onset | Duration | Key Notes |
| Etomidate/ imidazole derivative |
0.3
mg/kg given over 30 to 60 seconds |
<1 minute | 5 to 14 minutes | Best
all- around profile |
| Midazolam/ benzo- diazepine |
0.1 to 0.3 mg/kg | 2 to 3 minutes | 30 to 60 minutes | Amnesia, reversible |
| Fentanyl/ opiate |
1 to
2 micrograms/kg IV |
<1 minute | 30 to 60 minutes | Analgesia, reversible |
| Ketamine/ dissociative |
1 to 2 mg/kg | 1 minute | 10 to 30 minutes | Bronchodilation, amnesia, analgesia; avoid head injury (ICP) |
| Propofol | 1.0 to 2.0 mg/kg | 30 to 60 seconds | 3 to 5 minutes | May
cause hypotension |
Paralytics for Rapid Sequence Intubation
| Agent/Class | Dose | Intubation | Duration | Key Notes |
| Succinylcholine/ depolarizing |
2 mg/kg | 45 to 60 seconds | 6 to 12 minutes | Avoid
in hyperkalemia, neuromuscular disease, or ocular trauma PEDS: Do not repeat dose in small children |
| Rocuronium/ non depolarizing |
1.0 mg/kg | 45 to 75 seconds | 25 to 60 minutes | Can
also use as an infusion; tachycardia possible |
| Vecuronium/ non depolarizing |
0.1 mg/kg | 90
to 240 seconds |
25 to 120 minutes | Reversible:
few cardiovascular side effects |