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.
Steven Vela is a Certified Registered Nurse Anesthetist with over 20 years of clinical experience working with adults in a critical care level one trauma center in the Dallas-Fort Worth metroplex. He completed his Bachelor of Science in Nursing from Texas A&M University-Corpus Christi and earned his Master of Science in Nurse Anesthesia from Texas Christian University. His interests and clinical practice include airway management, sedation strategies, and extracorporeal membrane oxygenation (ECMO) specialty.
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