Administration of specific medications before induction and paralysis to mitigate potential adverse effects associated with intubation.
Indications
To prevent:
i. Increased intracranial pressure
ii. Sympathetic surge
iii. Bronchospasm
Timing:
Administered 3 - 5 minutes before induction.
Medications:
A. Lidocaine:
Dose: 1 - 1.5 mg/kg IV
- Used for suspected elevated ICP or reactive airway disease.
- Blunts the increase in ICP and suppresses the cough reflex
B. Fentanyl:
Dose: 1-2 mcg/kg IV
- Reduces the sympathetic response to laryngoscopy (tachycardia and hypertension).
Preparation:
- 1 ampoule (0.1 mg/2 mL)
- Dilute with 8 mL normal saline → 10 mL solution (10 mcg/mL concentration).
Administration:
- Give slowly over 3-5 minutes.
Warning:
- Avoid fast bolus to prevent chest wall rigidity.
Side Effect:
- Watch for hypotension, especially in patients with compromised hemodynamics.
C. Atropine
Dose: 0.01 - 0.02mg/kg IV, minimum 0.1mg
- Historically used in children (<1 year old) to prevent bradycardia caused by succinylcholine or vagal stimulation.
Key Considerations:
i. Pretreatment is NOT MANDATORY for all patients undergoing RSI.
ii. The decision to use pretreatment depends on the clinical context, anticipated complications, and the patient's underlying conditions.
iii. Avoid delaying RSI if pretreatment is not feasible or indicated. The primary focus remains on securing the airway quickly and safely.