Why Succs after Etomidate?

[ck8ws3]

I'm a critical care nurse who's worked in the inpatient setting my entire 10 years of my nursing career. I'm not transitioning to critical care nurse transport and have a few new potential duties, one of which includes supraglottic airways via I-GEL; completely new to me. I've done my research on succs and Etomidate, watched videos, etc. I guess to get right to the point, my question is this:

If you're giving Etomidate, general anesthesia, essentially putting the patient to sleep, why would you need to then follow up with a NBA, I.e. Succs or other? Just to relax the muscles, making it easier for advanced airway placement? I'm so curious to learn more. 

[akulahawkRN, ADN, RN, EMT-P]

You sedate first then use the neuromuscular blockers. It's incredibly frightening to the patient if they're awake and are paralyzed. If you don't sedate them, they'll remember everything you do to them until they're sedated adequately. It's basically a form of torture. 

Also the NMB's are used to completely relax the skeletal muscles which will (usually) greatly facilitate the intubation attempt. Once you paralyze the patient, you also take 100% responsibility for maintaining their airway. Lose that and your patient can suffer severe consequences such as anoxic brain injury or even die.

[Lipoma, BSN, RN]

The airway may also still be reactivate during manipulation (inserting ETT and keeping it there) even after inducing the patient using etomindate or propofol. So NMBAs such as sux and roc further helps to minimize such reaction and minimize bronchospasms. This ensures the patient is able to ventilate and perfuse efficiently. 

Also as the above poster stated, patient safety and comfort is most important. We do not want the patient to be frightened which can cause postop delirium so its best to sedate them first before paralyzing. Imagine trying to breathe spontaneously but that effort was taken away and you're still awake. 

[ck8ws3]

Thank you. The first portion of your comment is what I was trying to get from people. I figured the NBA was to help with ease of placement due to muscle relaxation. I 100% understand the sedate before NBA. I appreciate your input; thank you.