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Rapid Sequence Induction Neuromuscular Blocking Agents - Essay Example

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Airway management is a core lifesaving skill for any health care worker.In emergency and certain special preoperative cases for general anaesthesia,rapid sequence induction is performed for endotracheal intubation as a ‘standard of care’…
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Rapid Sequence Induction Neuromuscular Blocking Agents

Download file to see previous pages... In emergency and certain special preoperative cases for general anaesthesia, rapid sequence induction (RSI) is performed for endotracheal intubation as a ‘standard of care’. Emergency care staff should be well versed with this technique of airway management. Neuromuscular blockers (NMBs) are a group of drugs which are used for intubation. They play an important role in endotracheal intubation. Depending upon their mechanism of action, these drugs can be classified into depolarizing and non-depolarising agents. This essay will discuss aims, indications, technique and dugs, and complications of RSI. Separately, this essay will also focus upon the actions of depolarizing and non-depolarizing neuromuscular blockers. Rapid Sequence Induction Aims The aims of rapid sequence induction are to secure the airway as soon as the airway reflexes are lost, optimise oxygenation and ventilation, prevent contamination of the airways and lungs by aspiration of regurgitated oesophageal or stomach contents, or blood and prevent the complications of aspiration such as aspiration pneumonitis, hypoxemia and/or death (Sinclair & Luxton, 2005). Indications Rapid sequence induction is indicated in situations and patients where airway protection is immediately required and there is a danger of aspiration of regurgitated gastrointestinal contents and blood in the airway. It is performed in the operation theatre under controlled conditions, whereas in pre hospital setup, it is performed with limited resources and expertise (Sinclair & Luxton, 2005). It is performed in patients requiring intubation who are assumed to be ‘full stomach’ (non-fasting) and have a high risk of aspiration such as patients with traumatic brain or bodily injury and loss of consciousness, pregnant patients, patients with raised intra-abdominal pressure (ascites, obesity, chronic renal failure), head and neck injury and bleeding into the oral cavity or airway (Perry, Lee, Silberg & Wells, 2008; Bernard et al, 2009). Complications RSI can be associated with the following complications: 1. Failure to secure the airway and resultant hypoxemia, and organ damage or death (Sinclair & Luxton, 2005) 2. Interruption of chest compressions during cardiopulmonary resuscitation. 3. Unrecognised oesophageal or maintsem bronchial intubation 4. Complications due to under-dosing or over-dosing of drugs such as awareness, hypotension, hyperkalaemia, arrhythmias and cardiac arrest 5. Injury to oral and laryngeal structures 6. Raised intracranial and intraocular pressure and stress responses associated with laryngoscopy and intubation such as tachycardia, hypertension and bronchospasm (Sinclair & Luxton, 2005). Technique, drugs and dosages The opinions regarding the drugs, their dosages and their method of administration in RSI are changing (El-Orbany & Connolly, 2010). Conventionally, RSI has involved the components of preoxygenation, rapid administration of induction agents and muscle relaxants, cricoid pressure application (Sellick’s manoeuvre), endotracheal intubation and cuff inflation, and non-application of bag-mask or positive pressure ventilation (Bernard, 2006). A pre-calculated dose of induction agent is given followed by fast acting muscle relaxant and as the patient starts to lose consciousness, cricoid pressure is applied. After 45 seconds to one minute, laryngoscopy is done, patient is intubated and the cuff of endotracheal tube (ET) is inflated. Only after confirmation of endotracheal placement of the tube with EtCO2 and ...Download file to see next pagesRead More
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