A comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients.

TitleA comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients.
Publication TypeJournal Article
Year of Publication2000
AuthorsLaurin EG, Sakles JC, Panacek EA, Rantapaa AA, Redd J
JournalAcad Emerg Med
Volume7
Issue12
Pagination1362-9
Date Published2000 Dec
ISSN Number1069-6563
KeywordsAndrostanols, Emergency Service, Hospital, Female, Humans, Intubation, Intratracheal, Male, Neuromuscular Depolarizing Agents, Neuromuscular Nondepolarizing Agents, Prospective Studies, Statistics, Nonparametric, Succinylcholine
Abstract

OBJECTIVE: To compare rocuronium and succinylcholine for rapid-sequence intubation (RSI) in the emergency department (ED).

METHODS: A one-year prospective cohort comparison study was performed using a data collection form completed at the time of intubation. Data collected included the reason for the neuromuscular-blocking agent (NMBA) chosen, the time to onset of paralysis, and any complications encountered. Three ten-point numerical descriptor scales recorded the degree of body movement, vocal cord movement, and the physician's overall satisfaction with the extent of paralysis.

RESULTS: Succinylcholine was used in 382 patients and rocuronium was used in 138 (26% of all RSI) patients. The mean (+/- SD) times of onset of succinylcholine and rocuronium were 39 +/- 13 sec and 44 +/- 20 sec, respectively (p = 0.04). No patient desaturated and required assisted ventilations while waiting for paralysis to occur. Types of body movements were similar with the two agents, but less frequent with succinylcholine (median = 10, mean = 9.5 +/- 1.1) than rocuronium (median = 10, mean = 9.1 +/- 1. 5) (p = 0.01). Vocal cord movements were similar for succinylcholine (median = 10, mean = 9.2 +/- 1.6) and rocuronium (median = 9, mean = 9.0 +/- 1.6) (p = 0.15). The physician's overall satisfaction with the extent of paralysis was also higher for succinylcholine (median = 10, mean = 9.4 +/- 1.3) than rocuronium (median = 10, mean = 8.8 +/- 2.0) (p < 0.01). Only one complication, widening of the QRS complex secondary to succinylcholine use in a patient with unsuspected hyperkalemia, could be attributed to the choice of NMBA.

CONCLUSIONS: Both succinylcholine and rocuronium produced fast and reliable paralysis for RSI. Although succinylcholine had a faster onset and provided more relaxation, the difference had no clinical significance. Approximately a fourth of ED RSI patients qualified for use of rocuronium using these high-risk criteria.

Alternate JournalAcad Emerg Med
PubMed ID11099426
Faculty Reference: 
John C. Sakles, MD, FACEP