Rapid Sequence Intubation in Traumatic Brain-injured Adults

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2018 Jun 28

PMID 29946498

Citations 6

Authors

Nicholas Kramer

David Lebowitz

Michael Walsh

Latha Ganti

Affiliations

Soon will be listed here.

Abstract

Deciding on proper medication administration for the traumatic brain injury (TBI) patient undergoing intubation can be daunting and confusing. Pretreatment with lidocaine and/or vecuronium is no longer recommended; however, high-dose fentanyl can be utilized to help blunt the sympathetic stimulation of intubation. Induction with etomidate is recommended; however, ketamine can be considered in the proper patient population, such as those with hypotension. Paralysis can be performed with either succinylcholine or rocuronium, with the caveat that rocuronium can lead to delays in proper neurological examinations due to prolonged paralysis. Recommendations for post-intubation continuous sedation medications include a combination propofol and fentanyl in the normotensive/hypertensive patient population. A combination midazolam and fentanyl or ketamine alone can be considered in the hypotensive patient.

Citing Articles

The diverse effects of ketamine, jack-of-all-trades: a narrative review.

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Diagnosis and management of elevated intracranial pressure in the emergency department.

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Effects of intubation technique on intracranial pressure: a cadaveric study.

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Exogenous Ketones and Lactate as a Potential Therapeutic Intervention for Brain Injury and Neurodegenerative Conditions.

Omori N, Woo G, Mansor L Front Hum Neurosci. 2022; 16:846183.

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Posttraumatic midazolam administration does not influence brain damage after experimental traumatic brain injury.

Sebastiani A, Bender S, Schafer M, Thal S BMC Anesthesiol. 2022; 22(1):60.

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References

Kawaguchi M, Furuya H, Patel P . Neuroprotective effects of anesthetic agents. J Anesth. 2005; 19(2):150-6. DOI: 10.1007/s00540-005-0305-5. View

Rudy E, Turner B, Baun M, Stone K, Brucia J . Endotracheal suctioning in adults with head injury. Heart Lung. 1991; 20(6):667-74. View

Patanwala A, Erstad B, Roe D, Sakles J . Succinylcholine Is Associated with Increased Mortality When Used for Rapid Sequence Intubation of Severely Brain Injured Patients in the Emergency Department. Pharmacotherapy. 2016; 36(1):57-63. DOI: 10.1002/phar.1683. View

Sperry R, Bailey P, Reichman M, Peterson J, Petersen P, Pace N . Fentanyl and sufentanil increase intracranial pressure in head trauma patients. Anesthesiology. 1992; 77(3):416-20. DOI: 10.1097/00000542-199209000-00002. View

Lin C, Chen K, Shih C, Seak C, Hsu K . The prognostic factors of hypotension after rapid sequence intubation. Am J Emerg Med. 2008; 26(8):845-51. DOI: 10.1016/j.ajem.2007.11.027. View

Benson M, Junger A, Fuchs C, Quinzio L, Bottger S, Hempelmann G . Use of an anesthesia information management system (AIMS) to evaluate the physiologic effects of hypnotic agents used to induce anesthesia. J Clin Monit Comput. 2003; 16(3):183-90. DOI: 10.1023/a:1009937510028. View

Na H, Hwang J, Park S, Oh A, Park H, Jeon Y . Drug-administration sequence of target-controlled propofol and remifentanil influences the onset of rocuronium. A double-blind, randomized trial. Acta Anaesthesiol Scand. 2012; 56(5):558-64. DOI: 10.1111/j.1399-6576.2012.02648.x. View

Hanouz J, Zhu L, Persehaye E, Massetti M, Babatasi G, Khayat A . Ketamine preconditions isolated human right atrial myocardium: roles of adenosine triphosphate-sensitive potassium channels and adrenoceptors. Anesthesiology. 2005; 102(6):1190-6. DOI: 10.1097/00000542-200506000-00019. View

Jellish W, Riche H, Salord F, Ravussin P, Tempelhoff R . Etomidate and thiopental-based anesthetic induction: comparisons between different titrated levels of electrophysiologic cortical depression and response to laryngoscopy. J Clin Anesth. 1997; 9(1):36-41. DOI: 10.1016/S0952-8180(96)00211-5. View

10.

Upchurch C, Grijalva C, Russ S, Collins S, Semler M, Rice T . Comparison of Etomidate and Ketamine for Induction During Rapid Sequence Intubation of Adult Trauma Patients. Ann Emerg Med. 2016; 69(1):24-33.e2. PMC: 5180365. DOI: 10.1016/j.annemergmed.2016.08.009. View

11.

Grover V, Reddy G, Kak V, Singh S . Intracranial pressure changes with different doses of lignocaine under general anaesthesia. Neurol India. 1999; 47(2):118-21. View

12.

Flower O, Hellings S . Sedation in traumatic brain injury. Emerg Med Int. 2012; 2012:637171. PMC: 3461283. DOI: 10.1155/2012/637171. View

13.

Guldner G, Schultz J, Sexton P, Fortner C, Richmond M . Etomidate for rapid-sequence intubation in young children: hemodynamic effects and adverse events. Acad Emerg Med. 2003; 10(2):134-9. DOI: 10.1111/j.1553-2712.2003.tb00030.x. View

14.

Clancy M, Halford S, Walls R, Murphy M . In patients with head injuries who undergo rapid sequence intubation using succinylcholine, does pretreatment with a competitive neuromuscular blocking agent improve outcome? A literature review. Emerg Med J. 2001; 18(5):373-5. PMC: 1725690. DOI: 10.1136/emj.18.5.373. View

15.

Cohen L, Athaide V, Wickham M, Doyle-Waters M, Rose N, Hohl C . The effect of ketamine on intracranial and cerebral perfusion pressure and health outcomes: a systematic review. Ann Emerg Med. 2014; 65(1):43-51.e2. DOI: 10.1016/j.annemergmed.2014.06.018. View

16.

Langsjo J, Kaisti K, Aalto S, Hinkka S, Aantaa R, Oikonen V . Effects of subanesthetic doses of ketamine on regional cerebral blood flow, oxygen consumption, and blood volume in humans. Anesthesiology. 2003; 99(3):614-23. DOI: 10.1097/00000542-200309000-00016. View

17.

Dahlgren N, Messeter K . Treatment of stress response to laryngoscopy and intubation with fentanyl. Anaesthesia. 1981; 36(11):1022-6. DOI: 10.1111/j.1365-2044.1981.tb08676.x. View

18.

Alnemari A, Krafcik B, Mansour T, Gaudin D . A Comparison of Pharmacologic Therapeutic Agents Used for the Reduction of Intracranial Pressure After Traumatic Brain Injury. World Neurosurg. 2017; 106:509-528. DOI: 10.1016/j.wneu.2017.07.009. View

19.

Kim J, Shim J, Kim S, Ryu H, Yoon S, Jeon Y . Remifentanil vs. lignocaine for attenuating the haemodynamic response during rapid sequence induction using propofol: double-blind randomised clinical trial. Anaesth Intensive Care. 2007; 35(1):20-3. DOI: 10.1177/0310057X0703500102. View

20.

Samaha T, Ravussin P, Claquin C, Ecoffey C . [Prevention of increase of blood pressure and intracranial pressure during endotracheal intubation in neurosurgery: esmolol versus lidocaine]. Ann Fr Anesth Reanim. 1996; 15(1):36-40. DOI: 10.1016/0750-7658(96)89400-7. View