Abstract
Prehospital emergency anesthesia (PHEA) is a commonly performed prehospital procedure
with inherent risks. The processes and drug regimens behind PHEA are continually updated
by prehospital teams across the country as part of their governance structure. Essex
& Herts Air Ambulance has recently updated this practice by reviewing the entire process
of performing PHEA. Through experiential learning in a high-volume service, audit,
and a contemporary literature review, a new standard operating procedure has been
developed to combat common problems, such as hypotension, associated with the more
traditional methods of performing PHEA. The aim of this article was to summarize the
literature behind this new standard operating procedure, systematically breaking down
the core components of performing a PHEA and the rationale behind them. The key components
identified in the review are indications for PHEA, airway assessment, peri-intubation
oxygenation, preparation for PHEA, drug dosing, special circumstances, and failed
intubation. One significant change is the drug dosage regimen; 1 μg/kg fentanyl, 2
mg/kg ketamine, and 2 mg/kg rocuronium is recommended as the main drug dosing regimen
for both medical and trauma patients. Other changes include preoxygenation with a
nasal cannula in addition to the nonrebreather mask, optimizing patients in the preparation
phase by considering inopressors or fluid bolus and ensuring a “sterile cockpit” to
control the surrounding environment to ensure the first intubation attempt is the
best attempt.
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Article info
Publication history
Published online: September 22, 2022
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