ouseout=”window.status=”; return true;”>2 In routine anesthetic practice, in the elective case, the most commonly used IV anesthetics are propofol and sodium thiopental. Muscle paralysis improves intubating conditions by causing the relaxation of head and neck musculature and preventing the patient’s reflexive movements during direct laryngoscopy. Paralysis is frequently obtained with succinylcholine, which has rapid onset and a brief duration of action. In cases where succinylcholine is contraindicated or avoidance of its side effects is desired (Table 7-4), a nondepolarizing neuromuscular blocker such as rocuronium or vecuronium is often used.3 It should be noted that neuromuscular blockade is not always used in preparation for perioperative airway management —such medication is not used during any awake airway management interventions because continued spontaneous respiration is desired, and avoiding use of neuromuscular blockade may be appropriate in certain cases where overall pati”window.status=this.title; return true;” onmouseout=”window.status=”; return true;”>Table 7-1).1 This helps decrease the anxiety and fear commonly reported before surgical procedures. Oxygen is then provided to help maintain necessary blood oxygen content for homeostasis during the expected period of apnea that occurs after administration of intravenous (IV) general anesthetic agents (Table 7-2) and muscle relaxants (Table 7-3), which are provided to render a patient unconscious and paralyzed, respectively, for the planned airway intervention. Note that the anesthetic must be administered before the muscle relaxant so as to avoid the patient experiencing total paralysis while awake. The combination of anesthesia and paralysis serves an important role in optimization of conditions for intubation—movement is decreased, the patient is amnestic to the event, the vocal cords are relaxed and open, and the cough and gag reflexes are diminished.<A onclick="if (window.scroll_to_id) { scroll_to_id(event,'R2-7'); return false; }" onmouseover="window.status=this.title; return true;" onmouseout="window.status=''; return true;" title=2 class=LK href="#R2-7" name=to-R2-7 xpath="/CT{06b9ee1beed59419a70a2b44a923a9a919e6aa0a05fb19eaab5f1460e4f238153790f71a074c58e1cc7452a8056df2a4}/ID(R2-7)" (Table 7-4), a nondepolarizing neuromuscular blocker such as rocuronium or vecuronium is often used.3 It should be noted that neuromuscular blockade is not always used in preparation for perioperative airway management —such medication is not used during any awake airway management interventions because continued spontaneous respiration is desired, and avoiding use of neuromuscular blockade may be appropriate in certain cases where overall patient outcome might be jeopardized with its use (eg, procedures where motor function is to be monitored or patients with myasthenia gravis).4
Agent | IV Dose (mg/kg)a | Time to Onset (s) | Duration of Action afteo_id(event,’R2-7′); return false; }” xpath=”/CT{06b9ee1beed59419a70a2b44a923a9a919e6aa0a05fb19eaab5f1460e4f238153790f71a074c58e1cc7452a8056df2a4}/ID(R2-7)” title=”2″ onmouseover=”window.status=this.title; return true;” onmouseout=”window.status=”; return true;”>2 The patient in cardiac arrest likewise requires no pharmacologic intervention in order to place the endotracheal tube. Agent Dose Effect Midazolam 0.5-2 mg IV Anxiolysis, amnesia Diazepam 2.5-5 mg IV Anxiolysis Fentanyl 25-100 mcg IV Sedation, analgesia Morphine 2.5-5 mg IV Sedation, analgesia |
