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  1. 1. Anaesthetics Specific induction drugs: Resp- Ketamine (no resp depression) Cardio- Etomidate (no cardiac depression) Brain- Everything except ketamine Porphyria- Propofol (but you need to find out if there are known triggers) Malignant hyperthermia- All IV drugs Obstetrics- Epidural Paeds- inhalation preferred so that intubation can be done after Liver- IV because volatile agents decrease liver blood flow kidney- spinal/epidural A pneumonic for performing RSI is the 8 Ps: Preparation — prepare all necessary equipment, drugs and back-up plans Preoxygenation — with 100% oxygen Pressure on cricoid Premedication — depending on the patient, just the hypnotic agent Paralyze — suxamethonium or rocuronium Pass the tube — visualize the tube going through the vocal cords Proof of placement — using a reliable confirmation method Post intubation care — secure the tube, ventilate On NEJM.com: Conscious Sedation for Minor Procedures in Adults http://www.nejm.org/multimedia/medical-videos Do not use an anticholinesterase to reverse sux as they have a different MOA compared to non- depolarising muscle relaxants. Sux duration of action is 6-12 min & in old people its effects are prolonged as they have lower cholinesterase levels.(think scoline apnoea)To reverse a non-depolarising muscle relaxant give a anticholinesterase + anticholinergic to reverse the side effects of the anticholinesterase. Factors precipitating acute attack of Porphyria SAD FACE: S-Smoking A-Alcohol D-Drugs F-Fasting A-Abuse of Substances C-Cyclical factors ie menstruation E-Emotional stress Pharmacological changes with aging "Crumbly Old Fasted People Remember Horrible Wars" Cardiac Output decreased Fat content increased Protein binding decreased Renal function decreased Hepatic BF (& enzyme activity) decreased Water (TBW) decreased
  2. 2. Some random drug facts Drugs that depress the heart include: halothane, nitrous oxide, Propofol, Thiopental Induction of choice for heart problems: Etomidate Should you not be able to use Sux in RSI because of patient contra-indications use Rocuronium as it is the fastest acting non-depolarising muscle relaxtant Failed intubation causes: (INTUBATION) Infections of larynx Neck mobility abnormalities Teeth abnormalites (eg poor dentifom, loose and protuberant teeth) Upper airway abnormalities, strictures, or swellings Bullsneck deformities Ankylosing spondylitis Trauma/ Tumour Inexperience Oedema of upper airway Narrowing of lower airway Porphyrias: acute intermittent porphyria symptoms 5 P's: Pain in abdomen Polyneuropathy Psychologial abnormalities Pink urine Precipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)

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