| Title | A comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients. |
| Publication Type | Journal Article |
| Year of Publication | 2000 |
| Authors | Laurin EG, Sakles JC, Panacek EA, Rantapaa AA, Redd J |
| Journal | Acad Emerg Med |
| Volume | 7 |
| Issue | 12 |
| Pagination | 1362-9 |
| Date Published | 2000 Dec |
| ISSN Number | 1069-6563 |
| Keywords | Androstanols, 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 Journal | Acad Emerg Med |
| PubMed ID | 11099426 |
A comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients.
Faculty Reference:
John C. Sakles, MD, FACEP