The role of anesthetic induction agents and neuromuscular blockade in the endotracheal intubation of trauma victims

Management of extensive trauma often requires immediate tracheal intubation and mechanical ventilation. The role of anesthetic induction agents and neuromuscular blockade in the airway management of the trauma victim is disputed. To better define the role of these agents in the acute management of trauma, the adult trauma registry of The Johns Hopkins Hospital was reviewed to determine the frequency of use of these agents in acute airway management and to assess the effect of these agents on the incidence of complications. Ninety-seven patients were reviewed. Thirty-one patients were intubated because of cardiopulmonary arrest. Of the remaining 66 patients, oral intubation was initially attempted in 54. When drugs were used to facilitate intubation (n=36), the success rate was 92 per cent on the first attempt, and 100 per cent on the second attempt. When drugs were not used (n=18), 39 per cent could not be intubated (n=7). Subsequent drug administration resulted in successful intubation of five of seven of these patients. Nasal intubation (no drugs) was only successful in 60 per cent of the patients (50 per cent on first attempt). Four patients required a cricothyrotomy. Two other patients vomited, and one patient aspirated. None of these patients received drugs prior to the first attempt at intubation. No hemodynamic or neurologic complications, related to relaxant or induction agent use, were observed. These findings suggest that oral intubation with drugs to facilitate airway management is most likely to result in successful intubation on the first attempt and that drug use in the trauma setting is safe.