I often wonder why physicians continue to utilise competitive, long acting neuro-muscular blocking agents such as vecuronium for the initial RSI procedure.
Vecuronium is a neuro-muscular blocking agent with two important characteristics. At an intubating dosage it provides very predictable conditions in about 45 seconds, in order to intubate the patient. It predictably provides 45 minutes of paralysis and some cardiovascular stability. Vecuronium is a generic drug and therefore is very inexpensive
, as compared to rocuronium, atracurium and cis-atracurium.
Sch is a non-depolarizing neuromuscular blocker that is perfered by most for initial intubations, however, there are concerns with potassium levels with its usage. At intubating dosages, it is ready in 30-45 seconds with a duration of 5-10 minutes.
Etomidate is a amenesic agent that provides the best cardiovascular stabilty amoung these agents. Its onset is about 30 seconds lasting roughly 20-30 minutes with an intubating dosage. Thiopental and propofol both can produce profound hypotension with induction dosages, perhaps that is why it was not chosen.
Therefore, to answer your question Shannon, with the above medications used, additional sedation should be started around 30 minutes. Most physicians, that I deal with, would start a propofol infusion.
long acting neuro-muscular blocking agents such as vecuronium for the initial RSI procedure.
Maybe I am wrong, but by definition isn't RSI intubating with a pre-fasciculating dosage of tubo-curare, followed by thiopental and sch. I know very few people follow this today and most go with a modified RSI.