Re: Sedation vs. sedation/paralysis

[SUllrich@att.net]

I would agree that Etomidate is an excellent induction agent in the prehospital 
environment. The cardiac stability is a huge benefit for hypotensive patients.  
The one thing I was taught to remember is the short 1/2 life of the drug (2-5 
min).  Therefore, it should not be used for sedation after ventilation.  By the 
time the sux is gone, the etomidate is gone too.  So a little versed ASAP is a 
good thing.  Myoclonus with Etomidate is another potential problem if not used 
in conjunction with opiods or muscle relaxants.   Another thing to toss out 
here.  How many people give a nondepolarizing agent before the sux wears off?  
It's nice to keep them paralyzed so they don't do bad things to the tube but 
it's my understanding we may be masking a potential cholinesterase problem. 
They may have a cholinesterase deficiency or abnormal cholinestrase issues and 
you could end up with a prolonged phase II block that is unrecognized.  Any 
thoughts?

Steve Ullrich
> Allan,
> 
> Unfortunately we have not seen the same results with Etomidate.  In my 
> experience I have found it to be unreliable as a lone sedative for 
> intubation. Approximately 30 intubations thus far this year and have 
> witnessed Etomidate as the lone agent work 2 times.  We have found that 
> when a patient is combative/CHI they clinch down. It has been our 
> practice to have all RSI drugs ready. Usually the next is Anectine then 
> confirmation of ETT via ET Co2 (easy cap) then capnography as well as 
> auscultation. Then Norcuron to finish off RSI.  I seems that the 
> majority patients tend to clinch down after being given Etomidate.
> 
> It has only been somewhat reliable with cardiac pts.  It is our MCP 
> recommendation to use it with CHI and cardiac due to its beneficial 
> effects on decreased ICP and cardiac workload. But the majority of the 
> time we have been getting the job done with Versed / Anectine / 
> Norcuron. I do agree that Versed can also be unpredictable with it's 
> ability to sedate. But not as often as Etomidate. We also realized that 
> Etomidate was not designed as a stand alone sedative agent for RSI.
> 
> As for continued sedation we pretty much exclusively use Versed. 
> Etomidate at 0.3/kg is not written into our orders as a follow up 
> sedative to transport. Pretty much use it one time and if the desired 
> result  is not obtained then follow it up with the standard RSI drugs. I 
> know there is a positive benefit from giving Etomidate but it seems it 
> just doesn't produce the same or as often as Versed.  I often wonder if 
> our dosage could be increased to obtain the same results you are getting??
> 
> Rick Cosmar
> Medflight of Ohio
> 
> 
> _______________________________________________
> Flightmed mailing list
> To unsubscribe or change your email address, go to 
> http://www.pairlist.net/mailman/listinfo/flightmed
> 

_______________________________________________
Flightmed mailing list
To unsubscribe or change your email address, go to http://www.pairlist.net/mailman/listinfo/flightmed