The choice of medications for intubating a patient depends on the patient's medical history and the clinical situation. However, the process typically involves the use of induction agents and neuromuscular blocking agents (NMBAs) to facilitate rapid sequence induction and intubation.
Induction agents
- Etomidate, ketamine, or propofol: These are commonly used hypnotic agents for facilitating rapid sequence induction. The choice of agent depends on the patient's medical history and the clinical situation. Etomidate is often preferred for its hemodynamic stability, making it suitable for patients with cardiovascular compromise. Propofol provides rapid onset and short duration but can cause hypotension, thus it is less ideal for hemodynamically unstable patients. Ketamine is beneficial in patients with asthma or hypotension due to its bronchodilatory and sympathomimetic effects
Neuromuscular blocking agents
- Succinylcholine or rocuronium: These are commonly used NMBAs for rapid sequence induction and intubation. Succinylcholine is favored for its rapid onset and short duration, making it ideal for rapid sequence intubation. However, it is contraindicated in conditions like hyperkalemia, malignant hyperthermia, and certain neuromuscular disorders. Rocuronium, a non-depolarizing agent, is an alternative with a slightly longer onset but is useful when succinylcholine is contraindicated
Additional considerations
- Non-benzodiazepine sedatives: Non-benzodiazepine sedatives are preferred over benzodiazepine sedative drugs during tracheal intubation, as recommended by the JSBI 2022 guidelines
- Use of NMBAs in specific situations: The use of NMBAs has been associated with improved outcomes in certain situations. For instance, they have been found to decrease procedure-related complications during emergent tracheal intubation , improve intubation success in prehospital settings , and do not impair outcomes after traumatic brain injury
In conclusion, the choice of medications for intubating a patient should be individualized based on the patient's condition and the clinical context, with a typical regimen involving an induction agent and a neuromuscular blocking agent.