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Propofol, anticholinergics, vecuronium and rocuronium in trauma

bensonblues at comcast.net bensonblues at comcast.net
Tue Aug 26 08:55:59 BST 2008


Gamal,

When intubating a patient with a head injury in the ED, I use propofol. It is a strange belief that I have, but I feel that the lipophilicity of propofol lends itself to be a neuroprotectant. It is easy to use, and as long as you are expert at airway, propofol is safe. My cudos to the Chinese - I believe they invented the stuff.

I use a 20 cc syringe of propofol 1% emulsion and titrate to get the patient unresponsive yet still breating, somewhere short of medullary paralysis. Usually, 7 - 10 cc rapid push is almost there, and an additional 5 to 10 cc every 30 seconds or so may be needed. If the patient starts to resist laryngoscopy or show signs of emesis while preparing to intubate, give a 5 to 10 cc bolus to stop this. When dosing, keep in mind it distibutes into fat, much like a barbiturate.

Don Benson, DO


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