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- by maloneys Nov 24, '11What are you seeing most for bedside procedures, like intubation? We always used to use succ, along with versed, ketamine, etc. Now am seeing a trend towards etomidate. I'm wondering what others are seeing. I like that etomidate doesn't affect cardiovascular numbers like succ does. Wondering if this trend is a good one or if I'm missing something?
- Nov 24, '11 by CRNA1982"Succs" or Succinylcholine is a muscle relaxant. Etomidate is an anesthesia induction drug causing hypnosis. You never give Succs alone without Etomidate or some other drug for induction of anesthesia. Otherwise, you have a paralyzed patient with no hypnosis on board. For the most part, Succs does not effect cardiovascular numbers either. Although, it does cause some histamine release and bradycardia has been seen in pediatric patients; it is a very cardiac stable drug. Hope this helps.
- Nov 25, '11 by maloneysHi CRNA, yes, we always give some sedative with succ, as I mentioned, usually propofol, versed, etc. I was just wondering about the trend others are seeing, though, as I'm seeing certain docs use succ less and less, and trending towards etomidate for bedside procedures. I believe, though, that succ can effect HR and rhythm, though. Perhaps that is why?
- Nov 25, '11 by CRNA1982Succs is avoided in pts who have been bedridden or pts with a high serum K. Due to the mechanism of action of the drug, it causes K to be released from the motor end plate. Therefore it is avoided in bedridden pts and ones with high K, because it could lead to a sudden surge of extra cellular K and cardiac arrest. Anesthetic drugs are all chosen with the specific pts comprbidities in mind so that they remain hemodynamically stable and safe.
- Nov 25, '11 by maloneysThank you for taking the time to answer, CRNA!
- Nov 25, '11 by detroitdanoMost of our patients are contraindicated to get Succ for the reasons mentioned above. Muscular disorders, bedridden ESRD patients, etc.
Our go-to is Etomidate and Versed. If 2 rounds of each doesn't work out (still biting down, can't flex their head) then we call anesthesia and they bring the big guns. Only they are allowed to push Succ for intubations at our hospital.
- Nov 25, '11 by CRNA1982Amidate is a pretty forgiving drug therefore it is a good choice for inducing critical care pts. It is very cardiac stable and often pts. will continue to breathe, unlike propofol which can completely depress respirations. Obviously, when intubating "in not so good conditions" such as the ICU it is always good to keep the pt. breathing or not paralyzed in case one runs into a "cannot intubate", or even worse, "a cannot ventilate situation."
- Nov 30, '11 by gardengal1We use Etomidate exclusively for bedside procedures (reduction of dislocated joints). For intubation, we combine Succ with Etomidate pre-intubation as a 2 drug combo. For procedures, Etomidate is short acting with the patient waking back up in minutes rather than hours and discharges are more expedient after the required monitoring time and without many residual side effects.
- Jan 2, '12 by BelgianRNQuote from maloneysI found it quite interesting to read this because in our institution the exact opposite has happened. For years we used etomidate for the unstable ones and propofol for the stable ones as sedative of choice.Now am seeing a trend towards etomidate
Nearly all our emergent intubations nowadays are performed under rocuronium, ketamine and usually a benzo or opioid (this based on cardiovascular profile of the pt) to counteract the dissociative state ketamine induces. Only when ketamine is contra-indicated will we use etomidate.
In recent years emergent intubations with propofol have become rare in our instution due to the hemodynamic compromise it generally causes in the critically ill. Intubations with propofol in critically ill patients in our institution is generally frowned upon. Only time I see it nowadays is when intubating a hypertensive patient (e.g. neurosurgical candidates).