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. 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)
N20 is added to many patients as it provides extra pain relief while waiting on the opiods to work.