Intubation of the Neurologically Injured Patient

Abstract Background Intubation of the neurologically injured patient is a critical procedure that must be done in a manner to prevent further neurologic injury. Although many different medications and techniques have been used to meet specific needs, there is little to no evidence to support many cl...

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Bibliographic Details
Published in:The Journal of emergency medicine 2015-12, Vol.49 (6), p.920-927
Main Authors: Bucher, Joshua, MD, Koyfman, Alex, MD
Format: Article
Language:English
Subjects:
Adrenergic beta-1 Receptor Antagonists - administration & dosage
airway management
Airway Management - methods
Anesthetics, Dissociative - administration & dosage
Anesthetics, Intravenous - administration & dosage
Brain Injuries - therapy
Emergency
Fentanyl - administration & dosage
Hemodynamics - drug effects
Humans
intracerebral hemorrhage
Intubation, Intratracheal - methods
Ketamine - administration & dosage
neurologically injured patients
Propanolamines - administration & dosage
rapid sequence intubation
traumatic brain injury
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Summary:Abstract Background Intubation of the neurologically injured patient is a critical procedure that must be done in a manner to prevent further neurologic injury. Although many different medications and techniques have been used to meet specific needs, there is little to no evidence to support many claims. Objective To review the literature regarding important topics relating to intubating patients with neurologic injury. Discussion Airway management requires ideal preoxygenation and airway maneuvers to minimize manipulation of the larynx and to maximize first-pass success. There is no evidence that lidocaine pretreatment decreases intracerebral pressure (ICP). Fentanyl can be used to help blunt the hemodynamic response to intubation. Esmolol is another medication that can blunt the hemodynamic response. Ketamine can be used and is possibly the ideal agent, having a neutral hemodynamic profile. A prefasciculation dose for neuromuscular blockade has not been shown to have any effect on ICP. Conclusions Ideal intubation conditions should be obtained through the use of airway manipulation techniques and appropriate medication choice for rapid sequence intubation in patients who are neurologically injured.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2015.06.078