Expert: Ronald Levy, M.D. - 5/31/2008

Question
I am a flight paramedic with Emory Flight in Atlanta, Georgia and I have an anesthesia question.  Occasionally (actually rarely), due to pt hemodynamic instability (severe trauma, dissecting AAA, etc), that induction for ETI is done with a paralytic only.  Once hemodynamic stability is achieved, there is a medication, which I am unsure of, is utilized that essentially causes retrograde amnesia so that the experience of being intubated and then cut on without sedation or analgesia is wiped out.  It is not scopolamine, Versed, Propofol, Ketamine, etc.  Do you know the medication I am referring to?  Thanks in advance for your time and effort concerning this matter.
Sincerely,
Scott Flower

Answer
The only drugs I know that cause amnesia are the ones you mentioned so I am pretty sure that is what they used. As for intubating with only muscle relaxant, that is not a good idea because laryngoscopy is very stimulating and if the patient has an AAA, the increase in pressure could cause it to rupture. Better to sedate the patient before intubation.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston