The Intubation Farmacology

Obat-obat Induksi (menidurkan)

: Pharmacology
– Sodium Thiopental
 Induction, sedative
 Decreases ICP
 May cause or worsen hypotension.
 Bronchospasm in asthmatics
 Insufficient dose: laryngospasm
 3-5mg/kg (adults); 5-6mg/kg (peds) IV
Pharmacology
– Propofol
 Nonbarbiturate induction
 Decrease B/P
 Decreases ICP & IOP
 Potent respiratory depressant
 1-3mg/kg IV
 Onset: 15-30 seconds.
 Duration: 5-10 min.
Pharmacology
– Etomidate
 Nonbarbiturate induction
 Maintains B/P
 Decreases ICP & IOP
 Potent respiratory depressant
 0.1-0.4mg/kg IV
 Onset: <1 min.
 Duration: 10 min.
Pharmacology
– Ketamine
 Dissociative anesthesia/analgesic
 Central sympathetic stimulant: caution in patients
with cardiac disease or hypertension.
 C.I. in patients with intracranial trauma.
 Emergence reactions common.
 1-2mg/kg IV
 Onset: <1 min.
 Duration: ~5 min.
Obat-obat Pelumpuh Otot
Pharmacology
– Succinylcholine
 Depolarizing muscle relaxant: Fasciculations
 Ultrashort; Onset: 30-60 sec.; Duration: ~5 min.
 Bradycardia in children (Atropinization)
 Hyperkalemia in burns, crush injuries, and denervating
injuries > 5 days old.
 Caution: Spinal cord injury, burns, crush injuries,
prolonged immobility, renal disease, intraocular trauma.
 May increase ICP, intraocular & intraabdominal pressure.
 1-2mg/kg. IV (3mg/kg <1yr.; 2mg/kg >1yr)
Pharmacology
– Rocuronium
 Non-depolarizing muscle relaxant.
 No fasciculations.
 Onset 1 min.; Duration 30 min.
 Minimal CV effects (dose related tachycardia).
 Dosis 0.6 – 1.2 mg/kg IV
 Antidotum >> Sugamadex
Pharmacology
– Vecuronium
 Non-depolarizing muscle relaxant.
 No fasciculations.
 Onset 2-3 min.; Lasts ~ 30 min.
 Minimal CV effects (no tachycardia).
 0.1mg/kg IV for RSI; 0.01mg/kg maintenance.
 Rocuronium may be better than vecuronium when
succinylcholine is C.I.; quicker & shorter-acting.
 Obat Sedasi
Pharmacology
– Midazolam- benzodiazepine
 Anti-anxiety, amnesic, sedating.

 Reverses with flumazenil.

 Respiratory depression may worsen ICP.

 0.1mg/kg IV and titrate.

 Onset: 1-2 min.

 Obat Analgesi
Pharmacology
– Fentanyl- potent opioid compound.
 Analgesia/sedation.

 Onset: 2 min.

 Decreases ICP

 Supports B/P.

 Reverses with naloxone.

 5mcg/kg IV 3-5 min. prior to intubation.

 Obat Analgesi
Pharmacology
– Pethidin - opioid.
 Analgesia/sedation.

 Onset: 2 min.

 Allergic reaction

 Supports B/P.

 Reverses with naloxone.

 0.5-1mcg/kg IV 3-5 min. prior to intubation.

Pharmacology
– Lidocaine
 Local anesthetic, blunts arrythmias.
 Caution: Heart block, severe hypovolemia, CHF.
 Blunts pressor response.
 Limits increase in ICP
 1-2mg/kg IV 3-5min. prior to intubation.
 Obat Premedikasi
Pharmacology
– Atropine
 Premedication for infants & children receiving
succinylcholine
 0.01mg/kg, up to 0.5mg IV
 Never give < 0.1mg total due to paradoxical
bradycardia
 Rapid Sequence Intubation PROTOCOLS
– Paralysis for Intubation (Basic, Adult)
 Thiopental 3mg/kg or Midazolam 0.1mg/kg
 Cricoid pressure
 Succinylcholine 1mg/kg & air 60 seconds
 Intubate
 Release cricoid pressure
 RSI PROTOCOLS
– Paralysis for Intubation (Basic, Child<10)
 Atropine 0.01mg/kg
 Midazolam 0.1mg/kg
 Cricoid pressure
 Succinylcholine 2mg/kg
 Intubate
 Release cricoid pressure
 RSI PROTOCOLS
– Respiratory distress
 Ketamine 1mg/kg
 Atropine 10-20mcg/kg
 Midazolam 0.1mg/kg
 Cricoid pressure
 Rocuronium 0.9mg/kg
 Intubate
 Release cricoid pressure
 RSI PROTOCOLS
– Increased ICP or penetrating eye injury
 Lidocaine 1.5-2mg/kg
 Vecuronium 0.01mg/kg (priming dose)
 Atropine 0.01mg/kg for children
 Etomidate 0.3mg/kg/thiopental 4mg/kg
 Cricoid pressure
 Succinylcholine 1.5mg/kg/vecuronium 0.2mg/kg
 Intubate
 Release cricoid pressure
 BIBLIOGRAPHY
– Walker LA: Using Rapid Sequence to Facilitate Tracheal
Intubation. Emergency Med Reports 14:125-132, 1993.
– Chari R: Drugs for Conscious Sedation and Neuromuscular
Paralysis. Emergency Med Reports 19:9-20, 1998
– McAllister JD, Gnauck KA: Rapid Sequence Intubation of the
Pediatric Patient. Ped Clin NA 46:1249-1276, 1999.
– Pousman RM: Rapid Sequence Induction for Prehospital
Providers.
Www.ispub.com/journals/IJEICM/Vo14N1/rapid.htm.