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Thursday, March 14, 2013

Preventing the Burn: Safety of RSI Medications in Pregnancy

Very early on in my residency when I had my first experiences with rapid sequence intubation, my program director emphasized the importance of knowing the pregnancy categories and safety of these medications to "prevent getting burned" should such a situation arise.

Here is a chart that I made adapted from two references1,2 that I have kept handy ever since:

A previous post discussed the potential benefits of suggamadex as a reversal agent for vecuronium and rocuronium. Interestingly enough, there have been a number of studies that have evaluated its use in the setting of Cesarean delivery. However, more studies need to be conducted to evaluate its effects on both the maternal and fetal systems.

To emphasize, the benefits associated with the short-term use of these agents in such settings as rapid sequence intubation should outweigh the potential risks posed to both the mother and the fetus.

References:
1. Briggs GG, Freeman RK, Yaffe JS, ed. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.
2. Lexi-Comp Online, Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc.; Accessed 14 March 2013.

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