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Rapid sequence induction
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==== Premedication ==== Premedication is used to reduce anxiety of those who are going to be intubated and to reduce the anticipated physiological response of the patient during intubation.<ref name="Joanna 2014"/> * [[Midazolam]] – It is a fast-acting and the most [[lipophilicity|lipophilic]] of all [[benzodiazepine]] and rapidly crosses the [[blood–brain barrier]]. It is a [[gamma-aminobutyric acid]] (GABA) [[agonist]].<ref name=":3">{{cite book | vauthors = Lingamchetty TN, Hosseini SA, Saadabadi A |title=Midazolam |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK537321/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30726006 |access-date=2022-11-02 }}</ref> Usual doses for midazolam are 1 mg to 2 mg where the older people receive smaller doses and [[obese]] people receive higher doses. Midazolam is metabolized in the liver and is excreted through the kidneys.<ref name=":3" /> When midazolam is used alone, it has few side effects, but can cause respiratory depression if being used together with [[fentanyl]].<ref name="Joanna 2014">{{cite journal | vauthors = Stollings JL, Diedrich DA, Oyen LJ, Brown DR | title = Rapid-sequence intubation: a review of the process and considerations when choosing medications | journal = The Annals of Pharmacotherapy | volume = 48 | issue = 1 | pages = 62–76 | date = January 2014 | pmid = 24259635 | doi = 10.1177/1060028013510488 | s2cid = 8797670 }}</ref> * [[Fentanyl]] – It is a synthetic, centrally-acting [[opioid]]. It suppresses pain and sympathetic stimulation. Sympathetic stimulation can cause further injury to those with heart disease, [[aortic dissection]], and [[aortic aneurysm]]. Fentanyl is ideal because of its rapid onset, lack of [[histamine]] release, high lipophilicity, and short duration of action. The dosage is between 1 and 3 μg/kg. It is metabolized by liver. The most significant side effect is respiratory depression.<ref name="Joanna 2014"/> * [[Atropine]] – The process of intubation can cause massive stimulation to [[vagus nerve]], causing [[bradycardia]] (low heart rate). The people who are at increased risk of bradycardia are [[neonate]]s and children. This does not happen in adults because sympathetic stimulation overpowers the vagal response. However, for those adults who have received drugs such as [[beta blocker]], [[calcium channel blocker]], and [[digoxin]] have an increased risk of developing bradycardia. Atropine is a muscarinic receptor [[antagonist]], thus blocking the vagal response. The dose is 10 mcg/kg. It has quick onset of action, and common side effects are: increased heart rate, dry mouth, flushing, and urinary retention.<ref name="Joanna 2014"/> * [[Lidocaine]] – It is used to reduce the sympathetic response in those who have suspected raised [[intracranial pressure]] (ICP) or those who received [[succinylcholine]] which also causes increase ICP or those with underlying asthma that have [[bronchospasm]]. Administration of lidocaine can cause reduction in [[mean arterial pressure]] (MAP). The dosage is 1.5 mg/kg. This drug is metabolized by liver. The side effects are: hypotension, [[arrhythmia]] (irregular heart beat). Lidocaine can further interact with other drugs such as [[amiodarone]] and [[monoamine oxidase inhibitor]] to cause hypotension, and [[dronedarone]] to cause arrhythmia.<ref name="Joanna 2014"/>
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