Document Detail

Randomized, double-blind study on sedatives and hemodynamics during rapid-sequence intubation in the emergency department: The SHRED Study.
MedLine Citation:
PMID:  9506488     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: To compare thiopental, fentanyl, and midazolam for rapid-sequence induction and intubation (RSI). METHODS: Eighty-six patients undergoing RSI in the emergency department were randomly assigned in a double-blind fashion to receive either thiopental (5 mg/kg), fentanyl (5 microg/kg), or midazolam (.1 mg/kg) before paralysis was induced. Outcome measures were mortality, speed and ease of intubation, and hemodynamics. RESULTS: Of the patients who received thiopental, 93% were intubated within 2 minutes of paralysis (P=.037), but systolic blood pressure fell an average of 38 mm Hg in this group (P=.045). The midazolam group had a greater number of delayed intubations (31%) and an average heart rate increase of 17 beats/minute (P=.008). Mortality (24% inhospital) was unaffected by drug assignment. In all three groups, patients with pulmonary edema had the greatest decrease in blood pressure during RSI, and patients exposed to multiple attempts at intubation manifested pronounced hypertension. CONCLUSION: Fentanyl provided the most neutral hemodynamic profile during RSI, although factors other than choice of sedative can play a more significant role in determining hemodynamic response. Depth of sedation may influence the speed of RSI.
M L Sivilotti; J Ducharme
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  31     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  1998 Mar 
Date Detail:
Created Date:  1998-04-06     Completed Date:  1998-04-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  313-24     Citation Subset:  AIM; IM    
Department of Emergency Medicine, Royal Victoria Hospital, McGill University, Montreal, Canada.
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MeSH Terms
Aged, 80 and over
Anesthetics, Intravenous / pharmacology
Blood Pressure / drug effects
Central Nervous System Depressants / pharmacology*
Double-Blind Method
Emergency Service, Hospital
Heart Rate / drug effects
Hemodynamics / drug effects*
Hypnotics and Sedatives / pharmacology
Intubation, Intratracheal / methods*
Midazolam / pharmacology*
Middle Aged
Prospective Studies
Thiopental / pharmacology*
Reg. No./Substance:
0/Anesthetics, Intravenous; 0/Central Nervous System Depressants; 0/Hypnotics and Sedatives; 59467-70-8/Midazolam; 76-75-5/Thiopental
Comment In:
Ann Emerg Med. 1999 Jan;33(1):125-6   [PMID:  9867903 ]

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