Comparison of rocuronium and succinylcholine on postintubation sedative and analgesic dosing in the emergency department.

TitleComparison of rocuronium and succinylcholine on postintubation sedative and analgesic dosing in the emergency department.
Publication TypeJournal Article
Year of Publication2014
AuthorsKorinek JD, Thomas RM, Goddard LA, St John AE, Sakles JC, Patanwala AE
JournalEur J Emerg Med
Volume21
Issue3
Pagination206-11
Date Published2014 Jun
ISSN Number1473-5695
KeywordsAcademic Medical Centers, Adult, Aged, Analgesics, Androstanols, Cohort Studies, Dose-Response Relationship, Drug, Drug Administration Schedule, Emergency Service, Hospital, Female, Follow-Up Studies, Humans, Hypnotics and Sedatives, Intubation, Intratracheal, Male, Middle Aged, Neuromuscular Depolarizing Agents, Neuromuscular Nondepolarizing Agents, Retrospective Studies, Succinylcholine, Tertiary Care Centers, Treatment Outcome
Abstract

OBJECTIVES: Rocuronium and succinylcholine are both commonly used neuromuscular blockers for rapid sequence intubation in the emergency department (ED). The objective of this study was to determine if patients who receive rocuronium are more likely to receive lower doses of postintubation sedatives and analgesics compared with patients who receive succinylcholine.

METHODS: This was a retrospective cohort study carried out in a tertiary, academic ED. Consecutive adult patients, who were intubated using etomidate for induction of sedation, were included. Patients were categorized on the basis of whether they received (a) rocuronium or (b) succinylcholine for paralysis. The dosing of postintubation sedative and analgesic infusions were compared 30 min after initiation between the two groups.

RESULTS: A total of 254 patients were included in the final analysis (rocuronium=127 and succinylcholine=127). In the overall cohort, 90.2% (n=229) of patients were administered a sedative postintubation in the ED. Most of these patients were initiated on propofol infusions. The mean propofol infusion rate at 30 min was 30±23 mcg/kg/min in the rocuronium group and 42±24 mcg/kg/min in the succinylcholine group (P=0.002). A total of 42.5% of patients (n=108) received an analgesic infusion (all patients received fentanyl). The mean fentanyl infusion rate at 30 min was 0.65±0.55 and 0.86±0.49 mcg/kg/h in the rocuronium and succinylcholine groups, respectively (P=0.041).

CONCLUSION: Patients who receive rocuronium are more likely to receive lower doses of sedative and analgesic infusions after intubation. This may place them at risk of being awake under paralysis.

DOI10.1097/MEJ.0b013e3283606b89
Alternate JournalEur J Emerg Med
PubMed ID23510899
Faculty Reference: 
John C. Sakles, MD