ABSTRACT
LIDOCAINE AND ATROPINE Lidocaine can be given either topically or parenterally to help suppress coughing and other adverse airway reflexes such as laryngospasm and bronchospasm during instrumentation of the pharynx. Lidocaine is reported to help prevent a rise in intracranial pressure during intubation, conferring a possible cerebroprotective effect in head injured patients. Atropine, a parasympathetic blocker, is useful for preventing secretions and bradycardia when RSI is used in children. It is also reported to help reduce nausea and is recommended for any pediatric patient receiving succinylcholine. Glycopyrrolate (Robinul®) is similar to atropine, although due to its quaternary ammonium structure, is ionized at physiologic pH and does not cross the blood brain barrier, producing less sedation and central nervous system side effects than atropine.
FENTANYL Fentanyl citrate (Sublimaze®) is an injectable opioid analgesic with an onset of action of 7 to 8 minutes and duration of 1 to 2 hours. 100meg of fentanyl is equivalent to approximately 10 mg of morphine sulfate. All opiates act at the mµ1, mµ2, sigma, and kappa opioid receptors. Activation of the mu1 receptor provides analgesia and activation of mµ2 receptors are responsible for the sedative and respiratory depressive properties of opiates. Hemodynamic responses to intubation, such as elevation of the ICP, can be blunted when fentanyl is administered because of an attenuation in sympathetic output; however, if fentanyl is abruptly discontinued in a patient hemodynamically dependent on increased sympathetic stimulation, catastrophic cardiovascular collapse can occur. Fentanyl provides analgesia and sedation but not
