Airway management is an integral part of caring of critically ill patients, but is there anything that should be done differently in the neurologically injured patient?
Injured brains are particularly sensitive to hypoxia. Avoid it by appropriate positioning and preoxygenation.
Consider fentanyl and/or ketamine for sedation for RSI, as fentanyl can blunt the hemodynamic response to intubation, while ketamine is hemodynamically neutral and safe.
Consider Esmolol (1.5mg/kg) prior to intubation to prevent sympathomimetic surge during intubation in the absence of multiple injuries.
There is no role for the use of a defasciculating dose of neuromuscuclar blockade during RSI
References
Bucher J, Koyfman A. Intubation of the Neurologically Injured Patient. JEM 49 (6) 920-7
