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delayed sequence induction


  • A modification to usual RSI where procedural sedation is given to permit optimal pre-oxygenation
  • Ketamine is the prototypical agent used
  • Published by Weingart
  • A useful option in critically ill patients who are difficult to pre-oxygenate (ie due to agitation)
  • Low dose ketamine (eg 0.5mg/kg) is used to improve synchrony with non-invasive ventilation and to overcome some aspects of shunt physiology
  • Laryngeal reflexes are preserved until the neuro-muscular paralysis agent is given, which may be some minutes after the dissociative initial dose of ketamine (hence “delayed” sequence)
  • higher PEEP or CPAP can be delivered during the pre-ox phase because the patient is more manageable; this will in turn give higher oxygen saturations immediately prior to intubation and should improve the margin of safety
dsi.txt · Last modified: 2019/01/22 18:22 (external edit)