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sb439@gre.ac.uk's picture
by on Sun, 2018-04-08 00:19

I think I'm asking this in a very roundabout way below, but in short, critical care practitioners; is paralysis without sedation ever, under any circumstances an admissible course of action if sedatives are available?
Currently I think not, but I am not an anaesthetist or by any means an expert.
A discussion on social media and a confusing attempt at a literature search has led me to pursue some opinions here!
The discussion was a theoretical case of out-of-hospital management of a peri arrest stab victim. The suggestion of paralysis without sedation to facilitate intubation was made given the presence of profound hypotension.
Obviously there are enormous ethical issues with this and it would not be an action to take lightly. It seems to me that this used to be considered a very improbable course of action only to be taken in absolute extremis, but now I wonder whether this is the case at all with the rise of ketamine in the management of trauma patients. Hypotension is listed as a possible side effect and hypovolaemia a caution in the BNF, but with adequate fluid/blood resuscitation, is ketamine always going to be safe for these patients?
Thank you for sharing your thoughts!
Ben