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Why do we need NMBAs for RSI?
1. Why do we need NMBAs
for RSI
ผศ.นพ.สุรพงษ์ หล่อสมฤดี
TIVA Center
Division of Cardiothoracic and Vascular Anesthesia
Division of Transplantation Anesthesia
Chiang Mai University Hospital
8. Overview NMBAs
Succinylcholine
• Introduced in 1952
• Only depolarizing NMBA
• NMBA with the fastest onset and ultra-
short duration
• Used for routine intubation in the USA (not
for children)
• But in Europe mainly Rapid Sequence
Induction
• Elimination by pseudocholinesterase
16. TRACHEAL INTUBATION
Pre-Medication Meperidine 1 mg/kg
Atropine 0.01mg/kg
Induction Propofol to 2.5mg/kg
Alfentanil to 0.25 mg/kg
Rocuronium bromide 0.6 mg/kg OR
Succinylcholine chloride 1 mg/kg
Intubation 60 sec. later
17. ROCURONIUM BROMIDE:
TRACHEAL INTUBATION
• Median time to 80% block with
0.6 mg/kg is 60 seconds (0.4-
6.0 minutes)
• Median onset time with 0.6
mg/kg is 1.8 minutes (0.6-13
minutes)
23. Rationale for Selection of NMBs:
• Cardiovascular stability
• Nondepolarizing vs depolarizing
• Organ-independent elimination
• Clinically significant active or toxic
metabolites
• Predictability of duration
• Cumulative effects
• Reversibility
• Time to onset
• Stability of solution
24. Rapid Sequence
Intubation experience in
Emergency Department
Maharaj Nakorn Chiang Mai
นพ.บวร วิทยชำนำญกุล
Emergency Medicine
Chiang Mai University Hospital
26. • Establish Training EM in 2548
• Workshop RSI in January 2551
• RSI in ER October 2551
• Etomidate + Succinylcholine
• Etomidate + Rocuronium
• Propofol
34. Troubleshoot
• Hypotension after procedure
• > 1 attempt
– Non experience
– Position
– Not wait til onset of drugs
• Myoclonus 1 time
• Drug preparation time