Controversies in rapid sequence intubation in children.
OBJECTIVE
Rapid sequence intubation is the method of choice for intubation of the emergency department patient. The purpose of the present review is to address several controversies pertaining to emergency department rapid sequence intubation of children.


RESULTS
The topics covered in this review include the determination of the appropriate clinician to perform emergency department intubation, the use of atropine and lidocaine as premedications, the choice of sedative agents depending upon the clinical scenario, and the choice of neuromuscular blockade agent. Concerning these topics: The literature supports that emergency department physicians, with appropriate training, successfully perform intubation in most patients. Limited data exist to determine the appropriate use of atropine and lidocaine for rapid sequence intubation. Etomidate has clearly become a preferred sedative for rapid sequence intubation with a low risk of cardiovascular side effects. Thiopental and propofol may more readily provide adequate sedation as compared with etomidate but both have the potential to reduce blood pressure. Succinylcholine arguably remains the preferred neuromuscular blockade agent for rapid sequence intubation in most children. The side effects of succinylcholine occur in relatively predictable circumstances. Rocuronium is a commonly used nondepolarizing paralytic agent but its prolonged duration of action must be weighed against the risk of side effects associated with succinylcholine.


CONCLUSIONS
Though more research is needed, the available data allow for the development of protocols that will result in a rational, scenario-based approach to rapid sequence intubation in children.
Zelicof-Paul
Audrey
A
Department of Pediatrics, Emergency Division, The Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Smith-Lockridge
Arlene
A
Schnadower
David
D
Tyler
Sarah
S
Levin
Serle
S
Roskind
Cindy
C
Dayan
Peter
P
D000732:Androstanols; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D004636:Emergency Service, Hospital; D005045:Etomidate; D006801:Humans; D006993:Hypnotics and Sedatives; D007442:Intubation, Intratracheal / Q000379:methods*; D009467:Neuromuscular Depolarizing Agents; D000077123:Rocuronium; D013390:Succinylcholine
D000732:Androstanols; D006993:Hypnotics and Sedatives; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D000077123:Rocuronium; D005045:Etomidate