Higher dose fent as a premedication for RSI?

[FiremanMike]

Recently, our CCT protocol took away our 3mcg/kg premedication for RSI, going straight to etomidate or ketamine and then succs or roc. I had bought into the idea of some sympathetic blocking, pain and anxiety reduction (pre and post), and just general "extra sedation" granted by the pre-dose of fent. I've not really heard why we lost it (if I did, it went in 1 ear and out the other), and I just wanted to get everyone's feelings, opinions, and maybe some studies as to the effectiveness of fent for premedication during RSI.

 

[NomadicMedic]

We don't use it as premedication, but as a component of the post intubation cocktail. I think a fair explanation is, "that big chunk of plastic placed in your trachea is uncomfortable. Blunting the pain of that procedure is certainly something we should do as conscientious healthcare providers."

 

[Carlos Danger]

3 mcg/kg is a pretty hefty dose of fentanyl to push at once. Kind of works against the idea of sticking to the hemodynamic-friendly induction agents.

The only reason I can think of to give such a large dose as a premed is to blunt the SNS response, which isn't a huge concern in most patients.

 

[CANMAN]

I would be curious as to why they took it away from your protocols as well. Fentanyl is a fairly stable/predictable medication even in that dosage. We can do a Fentanyl/Versed induction for patient's in my full-time service which is a peds/neo program and our Fentanyl "slug" is typically 5mcg/kg.