Succinylcholine in Trauma

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The dose of any drug is enough. However, with ketamine you have two
functions and hence two doses; essentially it is a phenomenal analgesic in
low doses and a phenomenal anaesthetic (albeit a weird state called
dissociated anaesthesia but it looks just like any other once they are down)
and so you use it appropriately. The books say 0.3mg/kg for analgesia, 3 to
4mg/kg iv for anaesthesia and uniquely and sometimes very usefully you can
give it im at a dose of 10mg/kg. However, in the real world I use 25mg
increments for analgesia to effect - it is wonderfully progressive in
action. 150-450mg for anaesthesia works well. I agree that there isn't much
wrong in the controlled ED situation with traditional thio and sux. I'm
amazed people still think pretreatment with a non-depolarising drug is
needed - do they still spray the larynx with lidocaine too?

One big warning with sux though - remember it can release potassium from
cells in the burns patient surprisingly soon after injury - 24 hours is the
latest it should be considered.

Best Wishes,

Rowley. 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of William Bromberg
Sent: 22 August 2008 14:21
To: trauma-list at trauma.org
Subject: Re: Succinylcholine in Trauma


What's your dose of Ketamine?

bill bromberg

>>> <bensonblues at comcast.net> 8/22/2008 12:40 AM >>>
Anthony and Garth,
<snip>

I intubate at least one person a day in the ED who is non-fasting, tends to
have multiple medical problems, and is usually in extremis. I use ketamine
(propofol if head injury) and vecuronium .25 mgkg. The usual dose of
vecuronium is 0.1 mg/kg, but higher doses have been shown to have a faster
onset that approaches the onset of SCh. In the unlikely event that you need
to reverse the drug, 1 - 2 mg of physostigmine should do it. I stick with
this method because it has worked for me and my patients (so far, knock on
wood) for more than 20 years.

Really, whatever way you choose to skin your cat should be the one that
experience has proven to you to be the safest and most effective. Your track
record will speak for itself in the end.

Don Benson, DO, FACEP
St. John Hospital
Detroit
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