Medicines Used for Intubation

11 June, 2020
To properly intubate someone, doctors have to administer a series of medicines that we'll describe in this article.
 

Compromised airways and breathing is one of the leading causes of death and severe morbidity in adults and old people. Therefore, cardiopulmonary resuscitation techniques, like intubation, are one of the most important points when managing this type of emergency.

Intubation is a very common procedure in emergency services and intensive care, regardless of the condition that causes the need for this advanced airway procedure.

There are some obstacles to the procedure that come from the anatomy of the laryngeal structures, the limited time to fix the problem, and the poor visibility of the structures. Thus, medical professionals use certain medicines that help them intubate patients more easily.

What is intubation?

Doctor practicing intubation on a dummy.
Intubation is a technique that can save the lives of patients with respiratory failure.

Intubation consists of quickly inserting a tube in the trachea to provide an open pathway for air. When doctors insert the tube, the patient is able to breathe easier.

Intubation is the preferred method to control the airway of a patient due to the advantages it has. On the one hand, it isolates the airway, allowing it to stay open. It also prevents gastric insufflation, which is when the stomach fills with air.

 

On the other hand, it helps deep tracheal breathing and assures the patient gets a high concentration of oxygen. This procedure also eliminates the need for an adequately sealed face-mask and is an additional route for administering medication.

You might be interested in: The Effects of Breathing on the Brain

When do health professionals intubate someone?

There are precise directions about when to do this procedure, the most common being for cardiopulmonary arrestHowever, there are other situations that need intubation.

For example, patients that need to isolate or protect their airway, ones who suffered traumatic brain injury with a Glasgow scale rating below 8 points, or people with respiratory failure of more than 30 or less than 10 breaths per minute, are all patients that require intubation.

Additionally, doctors might intubate a person who has suffered imminent respiratory failure or those that have an edema in their airway, either due to burns or anaphylaxis.

Discover: Mechanical Ventilation Treatment

Medicines used in intubation

Doctors around a patient, performing intubation.
To ease the entrance of the intubation tube, doctors often use certain medicines.

During intubation, the body produces a powerful  adrenergic shock response that occurs with tachycardia, hypertension, and increased intracranial and ocular pressure.

 

For this reason, there is a preoxygenation stage in which doctors administer the following drugs to reduce this physiological response:

  • Lidocaine: doctors use this for patients with intracranial hypertension or increased bronchial reactivity. The recommended lidocaine dose is 1.5 mg/kg of weight, ideally 3 minutes before intubation.
  • Fentanyl: this is an opiooid that reduces the sympathetic nervous system response, that is, tachycardia and arterial hypotension. It’s important to be very careful when using this drug, since it can cause respiratory depression.
  • Atropine: doctors use this to prevent bradycardia in pediatric patients.
  • Phase-shifting dose of a neuromuscular blocker: currently this isn’t recommended, since doctors don’t know the true benefit caused by reducing muscle twitching. However, they do know the adverse effects of these types of medicines.

Other medications used

Regarding the induction and paralysis phase, they sequentially administer sedatives that lead to unconsciousness and then a neuromuscular relaxant, normally succinylcholine. Among the most common clinically used neuromuscular blocking and inducing agents are:

  • Etomidate: this the most widely used hypnotic induction drug. It doesn’t affect hemodynamics.
  • Ketamine: this is the only drug with hemodynamic stability comparable to etomidate. It’s a dissociative anesthetic. It causes catecholamine release, which increases heart rate, blood pressure, and cardiac output. It’s ideal for patients with hypotension.
 
  • Barbiturates: thiopental, like propofol, is often used in anesthesia. It’s recommended for patients with suspected intracranial hypertension who are hemodynamically stable.
  • Benzodiazepines: midazolam is the most commonly used drug from this category. It takes effect relatively quickly and has a short duration compared to other medicines in the same family. Additionally, it has a stronger amnesic effect.

 

  • Thomas, E. B. M., & Moss, S. (2017). Tracheal intubation. Anaesthesia and Intensive Care Medicine. https://doi.org/10.1016/j.mpaic.2016.10.013
  • Fehr, J. (2013). Nasogastric Intubation. In Practical Guide to Equine Colic. https://doi.org/10.1002/9781118704783.ch4
  • Tanaka, Y., Nakayama, T., Nishimori, M., Tsujimura, Y., Kawaguchi, M., & Sato, Y. (2015). Lidocaine for preventing postoperative sore throat. Cochrane Database of Systematic Reviews. http://doi.org/10.1002/14651858.CD004081.pub3
  • Mace, S. E. (2008). Challenges and Advances in Intubation: Rapid Sequence Intubation. Emergency Medicine Clinics of North America. http://doi.org/10.1016/j.emc.2008.10.002