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Reserve oral endotracheal intubation without pharmacologic assistance for the unresponsive and apneic patient. Intubate unconscious patients capable of resisting laryngoscopy or those with spontaneous respiratory effort with the assistance of pharmacologic adjuncts. Rapid sequence intubation (Chapter 16) optimizes conditions while minimizing the risk of aspiration. It can be performed with a high rate of success and minimal complications.1 Rapid sequence intubation requires the use of several pharmacologic adjuncts (Tables 12-1, 12-2, and 12-3). This includes a potent anesthetic agent to induce unconsciousness and a neuromuscular blocking agent to produce paralysis.

TABLE 12-1Recommended Anesthetic Doses of Pharmacologic Agents Used for Rapid Sequence Intubation
TABLE 12-2Recommended NMB Agents for Intubation and Rapid Sequence Intubation
TABLE 12-3Drug Interactions of NMB Agents


The ideal induction agent has an extremely rapid onset of action, produces predictable deep anesthesia, has a short duration of action, and has no adverse effects.2 Such an agent does not yet exist. There are at least six drugs that can safely be used for induction of anesthesia and intubation (e.g., etomidate, fentanyl, ketamine, methohexital, midazolam, propofol, and thiopental). ...

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