Question
Why do we need paralytics for intubation?
Answer
Paralysis will drastically improve intubating conditions. Your patient will be flaccid, making it easier to ventilate them, their vocal cords will be relaxed, and paralysis guarantees no diaphragmatic movement. The literature on this is convincing. Studies have shown that emergent intubations without the use of paralytic agents lead to an increase in adverse events. More recently, Walls et al. (2011) looked at 8,937 emergency department intubations and found that the likelihood of any associated event was 1.7 times higher with sedation without paralytics comparing to using sedation with paralytics. It is important to note the paralytics do just that. They only paralyze. When administrating a sedative before a paralytic, make sure the onset of your sedative has the same onset of action as your paralytics as there will be no awareness.
This Ask the Expert is an edited excerpt from the course, What’s Anesthesia Got To Do With It? presented by Steven Vela, MSNA, CRNA.
