Yamamoto L G, Yim G K, Britten A G
Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu.
Pediatr Emerg Care. 1990 Sep;6(3):200-13. doi: 10.1097/00006565-199009000-00010.
Emergency intubations are done for a variety of reasons in the emergency department (ED). In some patients, a rapid, controlled induction of anesthesia is useful to facilitate intubation and to reduce the complications of intubation. This is referred to a rapid sequence induction (RSI) in the anesthesia literature. Atropine, thiopental, fentanyl, diazepam, ketamine, vecuronium, succinylcholine, other drugs and their applications for RSI are described. The purpose of this article is to describe the use of RSI in the airway management of ED patients. Nineteen pediatric patients requiring emergency intubation were intubated using RSI with vecuronium and thiopental. Actual intubation difficulty using RSI was significantly less than the anticipated intubation difficulty without RSI. There were no complications caused by intubation or RSI that had a significant impact on patient outcome. We feel that a sedative in combination with vecuronium represents the most optimal means of achieving RSI in the ED setting. Although the induction of general anesthesia is best done by anesthesiologists, emergency physicians are often the most experienced physicians immediately available to manage an airway in a critical emergency. An objective protocol such as that described will make it easier for emergency physicians to perform this procedure when needed.
在急诊科，进行紧急气管插管有多种原因。对于一些患者，快速、可控的麻醉诱导有助于气管插管并减少插管并发症。在麻醉文献中，这被称为快速顺序诱导（RSI）。本文描述了阿托品、硫喷妥钠、芬太尼、地西泮、氯胺酮、维库溴铵、琥珀酰胆碱等药物及其在RSI中的应用。本文的目的是描述RSI在急诊科患者气道管理中的应用。19例需要紧急气管插管的儿科患者使用维库溴铵和硫喷妥钠通过RSI进行插管。使用RSI时实际插管难度明显低于未使用RSI时预期的插管难度。插管或RSI未引起对患者预后有重大影响的并发症。我们认为，镇静剂与维库溴铵联合使用是在急诊科实现RSI的最佳方法。虽然全身麻醉诱导最好由麻醉医生进行，但在危急情况下，急诊医生往往是最有经验的可立即处理气道的医生。像本文所述的客观方案将使急诊医生在需要时更容易进行此操作。
