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Bolus-only prehospital RSI maintenance highly variable

Maintenance of prehospital anaesthesia using an intermittent bolus regime in blunt trauma patients with a high GCS and hemodynamic reserve: a retrospective cohort study
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · Added 25 June 2026

Retrospective study showing that prehospital anaesthesia maintenance using intermittent boluses results in high variability of cumulative sedative/analgesic doses, potentially risking sub-therapeutic plasma levels.

Study type

Cohort

Design

Single-centre retrospective observational study at a UK HEMS

Participants

101 blunt trauma patients with GCS ≥9 undergoing prehospital anaesthesia

Main finding

Median prehospital anaesthetic duration 56 min; maintenance doses highly variable (fentanyl 0.64 [0-1.41] mcg/kg/h; midazolam 0.028 [0-0.041] mg/kg/h); 8 patients received no maintenance sedation or analgesia

Caveat

Retrospective, single-centre, homogeneous low-risk cohort; surrogate dosing measures only, no plasma levels measured

Bottom line

Hypothesis-generating

Learning goal

Refine my sedation and analgesia maintenance practice to avoid under-dosing during prehospital anaesthesia.

More

• Topic: Airway & ventilation
• Daily scan: 25 June 2026

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