Hızlı Seri Entübasyon ve Sık Kullanılan Ajanlar
Synopsis
Rapid sequence intubation (RSI) is a vital emergency intubation procedure in which an induction agent and a neuromuscular blocking agent are administered sequentially to secure the patient's airway. Prior to the procedure, a team decision should be made, the patient monitored, and preoxygenation provided with 100% oxygen for 3 minutes. The endotracheal tube size should be selected as 7.5–8.0 mm for females and 8.0–8.5 mm for males, and correct placement confirmed via end-tidal carbon dioxide measurement. Premedication agents such as lidocaine or fentanyl may be used after preoxygenation to attenuate potential increases in intracranial pressure and hemodynamic responses during the procedure. Among induction agents, short-acting etomidate protects against myocardial and cerebral ischemia, whereas propofol acts rapidly but is not preferred in trauma and shock patients due to its hypotensive effect. Ketamine provides bronchodilation and analgesia, making it preferred in status asthmaticus cases. Among neuromuscular blockers, depolarizing succinylcholine has a rapid onset but is contraindicated in hyperkalemia, burns, and crush injuries. Among non-depolarizing paralytics, rocuronium serves as an effective alternative to succinylcholine, while vecuronium is notable for its lack of cardiac effects, and their blockade can be reversed with sugammadex when needed. Proper management of agent duration, indications, and contraindications reduces morbidity and mortality.
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