Intubation pharmacology.

Rapid sequence intubation medications:

The goal of pharmacotherapy during intubation is to allow for safe intubation, decrease stress on heart, and reduce pain. Confirm dose of each drug with FDA label. Confirm concentrations per ml.

Lidocaine IV 1.5 mg /kg 1-3 min before intubation. Dose for 70 kg or 154 pounds = 105 mg IV

Off-label use prior to induction.

Comes in different concentrations for IV: 1% (10 mg of lidocaine in per ml ) 5 ml vials =50 mg

2% (20 mg of lidocaine in per ml ) 5 ml vials=100 mg

In 10 ml syringe 5 ml of 2% lidocaine plus 5 ml sterile water = 100 mg of lidocaine IV over 2 min

onset: 60 s; duration 10-20 min

Fentanyl 3 mcg/kg (high dose induction) Dose for 70 kg or 154 pounds = 210 mcg

analgesia and sedation; minimal negative cardiovascular effects

Comes as 50 mcg/1ml solution in 2 ml, 5 ml, 10 ml, 20 ml, 50 ml

in 10 ml syringe = 500 mcg for IV push = use 4 ml push. For rapid sequence intubation 5mcg/kg

in 3 ml syringe = 150 mcg for IV push = use up to 3 ml push

onset: immediate, duration: 30-60 min

Fentanyl 1 mcg/kg (low dose induction) Dose for 70 kg or 154 pounds = 70 mcg

low dose when in combination with sedative like midazolam

analgesia and sedation; minimal negative cardiovascular effects

Comes as 50 mcg/1ml solution in 2 ml, 5 ml, 10 ml, 20 ml, 50 ml amps

in 3 ml syringe = 150 mcg for IV push = use 0.5 to 1 ml up to 3 ml push

onset: immediate, duration: 30-60 min

Etomidate 0.3 mg/kg Dose for 70 kg or 154 pounds = 21 mg

sedative; minimal negative cardiovascular effect

Comes as 2mg/1ml solution in 10 or 20 ml vials

in 10 ml syringe = 20 mg for IV push

onset: 1 min, duration: 3-5 min

Ketamine (Ketalar) 1.5 mg/kg Dose for 70 kg or 154 pounds = 105 mg

sedative, analgesic via dissociation

Comes as 10mg/ml, 50 mg/ml, 100 mg/ml

If using 10mg/ml in 10 ml syringe = 100 mg for IV push over 1-2 minutes

onset: 30 s, duration 5-10 min for anesthetic effect and 1-2 hours for pain

Pre treatment with atropine and benzodiazepine may reduce salivation and vivid dreams in recovery

Propofol 2 mg/kg in 40 mg boluses Dose for 70 kg or 154 pounds = 140 mg

anesthetic

Comes as 10mg/ml vials of 100mg/10 ml, 200mg/20 ml, 500 mg/50 ml

If using 10mg/ml in 10 ml syringe = 100 mg for IV push in approx 40 mg boluses

onset: 30 s, duration 3-10 min redistribution and accumulation

Atropine sulfate IV from 0.1 mg to max of 0.5 mg Dose for 70 kg or 154 pounds = 0.1 mg

Off-label for rapid sequence intubation may decrease salivation and avoid bradycardia

Rapid injection

Comes as 1mg/1ml solution

Dilute in 10 ml to have 0.1 mg/ml IV

Onset: immediate, duration 5 min if IV, 60 min if IM

Succinylocholine 1.5 mg/kg Dose for 70 kg or 154 pounds = 105

Muscle relaxant

Comes as 20 mg/ml

In 10 ml syringe: 200 mg, push 5 ml

Onset: 30 s, duration: 3-5 min