Harvey and Jay - Thanks for your responses. I agree that the optimum
conditions for RSI are created by the combination of general anesthetic
(eg, thiopental or propofol or etomidate) + NM paralysing agent.
I brought up the issue of 'etomidate-only' intubation because I came
across a letter in the American Journal of Medicine (January 1998) on
this subject, where the proponents of its use suggested that it was
useful in the situation where the patient had a situation of antecedent
hypoxia and/or cardiovascularly instability + ? abnormal upper airway
anatomy with a "possible" difficult airway situation. The author
suggested that etomidate-alone created sufficient muscle relaxation and
depression of conciousness to create a good intubating-situation without
having to paralyse the patient. I have personally never used etomidate
so I did not know whether this recommendation was valid. I have read
that etomidate causes myoclonus and I wondered whether it also
occasionally caused bruxism => thereby actually increasing the
difficulty with intubation.
Jay - do you think that using rocuronium in the ED setting, where it is
difficult to 100% anticipate a "difficult" airway and a "CVCI" (cannot
ventilate-cannot intubate) situation, carries too great a risk - becuase
it causes such a prolonged state of neuromuscular paralysis?
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