General Anesthetics / Paralytic Question

[wilhi4, MSN, RN]

Hi all! In my pharmacology class, we're learning about general anesthetics and I was just hoping for some clarification. So, for example, with an intubation, the patient is given etomidate and succinylcholine. The etomidate is the anesthetic which makes the patient unconscious and then the succ is what will paralyze the patient. after intubation is the patient on a continuous etomidate and succ IV drip in order to stay unconscious and paralyzed? I worked in the ED as a scribe and I would often see physicians order a Propofol drip after a patient was intubated. Would this take place of the original anesthetic, in this case etomidate?

Just trying to fit the pieces together for better understanding. Thanks!!

[PeakRN]

So without getting way too in depth, what you are describing is RSI vs Sedation management.

Typically etomidate and Suc are given as RSI agents and are their properties are good for RSI but poor for sedation management. Often there are drugs that are better for prolonged sedation; in adults this is why we see a lot of propofol after the initial intubation has been performed. The choice of which drugs to continue sedation with deals greatly with why the patient was intubated in the first place and what their current physiological status is.

[Kuriin, BSN, RN]

A MD should order Propofol, Precedex, or any other continuous sedation drip during the initial intubation order.

[Here.I.Stand, BSN, RN]

The pt is typically sedated following intubation; at my hospital, propofol and fentanyl is the most widely used. The pt is only kept paralyzed with medical indication, e.g. while in the OR, in severe ARDS, having high ICPs not responding to prn's, etc.

[wilhi4, MSN, RN]

Ahh I understand now! Thanks for your help! :)