Rapid Sequence Intubation Dosing for 50kg Patient with GCS 8
For a 50kg patient with GCS 8 requiring rapid sequence intubation, administer etomidate 15mg IV (0.3 mg/kg) followed immediately by rocuronium 50mg IV (1.0 mg/kg). 1
Induction Agent: Etomidate
Etomidate should be dosed at 0.3 mg/kg IV, which equals 15mg for this 50kg patient. 2, 1
- The Society of Critical Care Medicine recommends etomidate as a first-line sedative-hypnotic induction agent for rapid sequence intubation in critically ill adults due to its favorable hemodynamic profile 2, 1
- This standard dose of 0.3 mg/kg provides adequate sedation while minimizing cardiovascular effects 2, 1
- Administer etomidate as a single IV bolus over 30-60 seconds 3
Critical Timing Consideration
- The sedative-hypnotic agent MUST be administered before the neuromuscular blocking agent to prevent awareness during paralysis 1
- Etomidate's duration of action (3-12 minutes) is significantly shorter than rocuronium's paralysis duration (25-73 minutes), so additional sedation must be planned immediately post-intubation 4
Neuromuscular Blocking Agent: Rocuronium
Rocuronium should be dosed at 1.0 mg/kg IV, which equals 50mg for this 50kg patient. 2, 1
- The Society of Critical Care Medicine strongly recommends administering a neuromuscular blocking agent when a sedative-hypnotic induction agent is used for intubation 2, 1
- Rocuronium at 1.0-1.2 mg/kg provides optimal intubating conditions comparable to succinylcholine 1
- Administer rocuronium immediately after etomidate, as early as practical after induction to minimize apnea time 1
Onset Time
- Wait at least 60 seconds after rocuronium administration before attempting intubation 1, 5
- Studies demonstrate that rocuronium 0.6 mg/kg provides acceptable intubating conditions at 60 seconds, and higher doses (1.0 mg/kg) improve conditions further 5, 6
Special Considerations for GCS 8 Patient
A GCS of 8 is a clear indication for tracheal intubation in brain-injured patients. 2
- Guidelines from the Association of Anaesthetists recommend intubation for GCS ≤8 to protect airway reflexes and prevent secondary brain injury 2
- Maintain mean arterial pressure >90 mmHg and systolic blood pressure >110 mmHg during the procedure 2
- Target PaCO2 of 4.5-5.0 kPa (approximately 34-38 mmHg) to avoid both hypercarbia and excessive hyperventilation 2
Critical Pitfalls to Avoid
Do NOT use higher doses of etomidate (>0.3 mg/kg) as this increases risk of respiratory depression without improving intubating conditions. 2, 3
- Have vasopressors immediately available as both etomidate and the intubation procedure itself can cause hypotension in critically ill patients 1
- Ensure sugammadex is available for reversal when using high-dose rocuronium in case of "can't intubate, can't ventilate" scenario 2, 1
- Plan for immediate post-intubation sedation (within 15 minutes) as 63% of patients in one study experienced ongoing paralysis without adequate sedation when additional sedatives were delayed 4
Hemodynamic Monitoring
- Use invasive arterial blood pressure monitoring if time permits, or non-invasive blood pressure at 1-minute intervals during peri-intubation period 2
- Position patient with head-up tilt (semi-Fowler position) to improve first-pass success and reduce aspiration risk 1
- Apply manual in-line cervical spine stabilization if trauma mechanism present 2