The differences in RSI vs Gas

RSI quick over view. Say you premed with versed and fent. Pt on OR table, preoxygenate for a while with 100% o2. give induction agent propofol, etomidate, thiopental, or what ever you are using so the pt goes to sleep, then give relaxant sucs, or a nondepolarizes vec, roc ect. With the RSI you do not ventilate the pt after you admin the induction agent. You push all the drugs quickly, DL and intubate. RSI will be done usually if the pt is at risk for regurge.

With a standard induction you will go a little slower and attempt to ventilate before you give the succs.

Yes etomidate and sucs are used freq and propofol probrably even more freq than etomidate.

Usually you premed with a benzo maybe and opiod and lido maybe and then induce (put them to sleep) with an induction agent such as propofol, etomidate, thiopental ect. After inducing the relaxant is given and tube placed. Once tube verified you maintain with a volatile agent or nitrous.

Inhaled inductions are done at times as well total IV anesthesia is done too.

Hey Mike. Overjoyed to see that you are doing the CRNA thing.
As far as propofol as an induction agent, I would say that we use it about 70% of the time where I am at - level one trauma center. Outpatient surgery centers use it almost exclusively as an induction agent. Amidate is getting a closer look at our facilty by our docs and one trauma fellow is doing a serum cortisol study following intubation with etom. Results should be in before the year is up. Old school thought was a that a single induction shot of etom had only a very transitory inhibition of 11-betahydroxalayse and subsequent cortisol, but now more information is coming to light...we'll have to see. Anyway, sometimes use amidate for poorly compliant heart patients going for non-cardiac surgery. Some neuro guys like to rebolus amidate prior to cranial clipping. Most of our hearts get a high dose fentayl and versed induction.

Some cases do indeed call for TIVA - total intravenous anesthetic. Monitored backs and necks sometimes get TIVA. We run propofol for those cases. Actually most of our necks and backs that have nerve monitoring studies done intraop get 1/2 MAC iso (or an end-tidal of 0.6) and IV propofol for additional sedation / anesthesia at considerable rates without paralysis. So yes there are indications to run gas and IV agents at the same time.

Man as far as the gases go, there is such a difference in how they work vs not only the different variables amongst themselves (sevo, iso, des) but very different than IV agents - dude your gonna have to read a pharm book for that. Can provide some excellent reading if you need a list.

Congrats on choosing anesthesia. Good questions btw. I can see you are going to keep your pharm / physiology instructor on his or her toes.

Reasons for lidocaine: 1. to take the sting out of induction doses of propofol, esp in a hand or worse, wrist vein.
2. blunt the ANS response to cold steel in da' mouf and shoving a garden hose thru cords.

There are also proponents of using what we call a LTA. Do a DL and stick this white narrow stick thru the cords, watch a black line go thru, then inject the 2% lido at the other end. It sprays lido ALL OVER THE PLACE, basically anesthetizing the skin where the cuff will be inflated.

Mike you are going to be amazed at the compliance of an anesthesia circuit compared to an ambu. We use a single tube (really a tube within a tube) and have the soft green bags to ventilate with. You can tell so much about what is going on rather than the damned ambu. Some institutions I have been to have a true double circuit attached to a bag that is rather stiff and I hate those systems.