Etomidate causes disinhibition of cortical activity, which causes the
twitching (most likely). Twitching and muscle activity is commonly seen
with induction agents of all sorts, notoriously methohexitone.
Ketamine is indeed useful in the severely asthmatic; Strube and Hallam
(1986) have used it by infusion to avoid intubation.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 19 January 2003 22:53
To: [log in to unmask]
Subject: Re: SIGN Paediatric Sedation Guidelines
----- Original Message -----
From: "Rowley Cottingham"
Subject: Re: SIGN Paediatric Sedation Guidelines
> It is not a drug of choice because there are better agents out there.
> It
is of course perfectly possible to give
> a muscle relaxant after ketamine, but which of ketamine's advantages
> over
other agents are you making use
> of?
Oh, this came up during the discussion about RSI in asthmatics Rowley,
so I was referring to bronchodilation properties. But I don't know if
there is any good evidence, it could just be one of these old
anaesthetists'/wives' tales!
> I agree that propofol or etomidate (depending on how hypovolaemic the
patient is) are much better
> induction agents.
But doesn't etomidate have an even greater propensity to produce
involuntary movements and emesis; they used to call it "twitch and
vomit" didn't they?
> > Ah I see!! Forgive me for being a bit slow! It's kinda neat though;
> > the same anaesthetist could help to resuscitate the baby after he's
> > finished with Mum. The mind boggles...
> BTDT. I have resuscitated countless babies after LSCS, occasionally
pushing the paediatrician (yesterday
> GP trainee sitting with GP, today paediatric SHO) out of the way to do
> so.
Yes I'm sure Rowley; I was being a tad facetious, I'm well aware that
most so-called adult anaesthetists are perfectly capable of stepping in
to resus a child. It's just sad that the modern trend is to push
subspecialisation to such a limit that we risk no longer seeing this
versatility in the very near future.
Adrian Fogarty
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