Airway management is an integral part of caring of critically ill patients, but is there anything that should be done differently in the neurologically injured patient?

• Injured brains are particularly sensitive to hypoxia. Avoid it by appropriate positioning and preoxygenation.
• Consider fentanyl and/or ketamine for sedation for RSI, as fentanyl can blunt the hemodynamic response to intubation, while ketamine is hemodynamically neutral and safe.
• Consider Esmolol (1.5mg/kg) prior to intubation to prevent sympathomimetic surge during intubation in the absence of multiple injuries.
• There is no role for the use of a defasciculating dose of neuromuscuclar blockade during RSI

References

Bucher J, Koyfman A. Intubation of the Neurologically Injured Patient. JEM 49 (6) 920-7