From the Research
For rapid sequence intubation (RSI), the best medication combination typically includes etomidate (0.3 mg/kg IV) as the induction agent and succinylcholine (1-1.5 mg/kg IV) as the neuromuscular blocking agent, due to their rapid onset and hemodynamic stability, as supported by the most recent study 1. The choice of medications should be tailored to the patient's specific condition, with consideration of hemodynamic status, potential difficult airway, and any contraindications to specific agents.
- Etomidate is often preferred as the induction agent due to its hemodynamic stability and rapid onset (30-60 seconds) 1.
- For patients with cardiovascular instability, ketamine (1-2 mg/kg IV) is an excellent alternative as it maintains blood pressure 1.
- For neuromuscular blockade, succinylcholine provides the fastest onset (45-60 seconds) with short duration, making it ideal for emergency situations when there are no contraindications 2.
- Rocuronium (1-1.2 mg/kg IV) is the best alternative when succinylcholine is contraindicated, with a slightly longer onset (60-90 seconds) at higher doses 1.
- Pre-treatment with fentanyl (1-3 mcg/kg IV) 3 minutes before induction can blunt sympathetic response in patients with increased intracranial pressure or cardiovascular disease 1.
- Lidocaine (1.5 mg/kg IV) may be used 2-3 minutes before induction to reduce airway reflexes in patients with reactive airway disease or increased intracranial pressure 1. The most recent study 1 provides the most up-to-date guidance on the selection of medications for RSI, and its findings should be prioritized in clinical practice.