Rapid sequence intubation (RSI) outside of the operating room in children: Medications for sedation and paralysis
- Dewesh Agrawal, MD
Dewesh Agrawal, MD
- Associate Professor of Pediatrics and Emergency Medicine
- Children's National Medical Center
- Section Editor
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will discuss medications commonly used for sedation and paralysis outside of the operating room during RSI in children. The approach to RSI outside of the operating room in children, including the steps involved in performing RSI and the selection of sedative and paralytic agents according to patient characteristics, is discussed separately. (See "Rapid sequence intubation (RSI) outside the operating room in children: Approach".)
RAPID SEQUENCE INTUBATION
RSI describes a sequential process of preparation, sedation, and paralysis to facilitate safe, emergency tracheal intubation. Pharmacologic sedation and paralysis are induced in rapid succession to quickly and effectively perform laryngoscopy and tracheal intubation.
The goal of RSI is to quickly and safely intubate patients using sedation and paralysis. A simple, systematic approach to preparation and execution of the procedure is necessary in order to perform RSI quickly and safely (table 1 and figure 1). This approach is discussed in detail separately. (See "Rapid sequence intubation (RSI) outside the operating room in children: Approach", section on 'Approach'.)
Sedative agents are integral to the performance of RSI. They provide amnesia, blunt sympathetic responses, and can improve intubating conditions.
Each of the major induction agents in common use in children is discussed below and provided in the rapid overview (table 1). Further information about selection of sedatives and paralytics for RSI in children according to serious underlying conditions (eg, hemodynamic instability, increased intracranial pressure, status asthmaticus, or status epilepticus) is provided separately. (See "Rapid sequence intubation (RSI) outside the operating room in children: Approach", section on 'Selection of sedative agent' and "Rapid sequence intubation (RSI) outside the operating room in children: Approach", section on 'Selection of paralytic agent'.)
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