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