EBQ:Comparison of Succinylcholine and Rocuronium for RSI: Difference between revisions
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! Common Indications for Rocuronium Use | ! Common Indications for Rocuronium Use | ||
! Number of Patients | ! Number of Patients (%) | ||
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| Suspected hyperkalemia | | Suspected hyperkalemia | ||
| 53 | | 53 (38%) | ||
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| Chronic renal failure | | Chronic renal failure | ||
| Line 70: | Line 70: | ||
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| Lack of medical history | | Lack of medical history | ||
| 43 | | 43 (31%) | ||
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| Known hyperkalemia | | Known hyperkalemia | ||
| 11 | | 11 (8%) | ||
|- | |- | ||
| Neuromuscular disease | | Neuromuscular disease | ||
| 11 | | 11 (8%) | ||
|} | |} | ||
Common sedative agents used: | |||
*Etomidate: 464 patients (89%), mean dose 0.29 mg/kg | |||
*Midaolam: 12 patients(2%), mean dose 0.09 mg/kg | |||
*Obtunded--no sedative used: 15 patients (3%) | |||
*No sedation recorded: 14 patients (2%) | |||
==Criticisms & Further Discussion== | ==Criticisms & Further Discussion== | ||
Revision as of 17:20, 16 September 2015
Under Review Journal Club Article
Laurin EG, et al. "A Comparison of Succinylcholine and Rocuronium for Rapid-sequence Intubation of Emergency Department Patients". Academic Emergency Medicine. 2000. 7(12):1362-9.
PubMed PDF
PubMed PDF
Clinical Question
How do succinylcholine and rocuronium compare for use is rapid-sequence intubation in the emergency department?
Conclusion
Both succinylcholine and rocuronium produce fast and reliable paralysis for RSI in the ED.
Major Points
| Result | Succinylcholine | Rocuronium |
|---|---|---|
| Time of Onset (± SD) | 39 (± 13) seconds | 44 (± 20) seconds |
| Mean Dosage | 1.7 mg/kg | 1.0 mg/kg |
| Satisfaction 0-10 (± SD) | 9.4 (± 1.3) | 8.8 (± 2.0) |
Study Design
- Data form completed by intubator immediately after intubation with following info
- Patient's name, age, gender, paralytic used, reason for use, time from administration to paralysis, serum K at time of intubation, need for BVM ventilations, pulse ox readings during intubation, any complications
Population
Patient Demographics
- Mean age: 46 years old
- Range: days old-96 years old
- Male: 63%
Inclusion Criteria
- Every patient intubated in the ED from January 1, 1998 to December 31, 1998 was eligible for enrollment
Exclusion Criteria
Interventions
Prospective observational study of paralytic use in ED
Outcomes
N= 521 patients who received RSI in the ED
- 382 (73%) received succinylcholine
- 138 (26%) received rocuronium
Indications for
| Common Indications for Rocuronium Use | Number of Patients (%) |
|---|---|
| Suspected hyperkalemia | 53 (38%) |
| Chronic renal failure | 28 |
| Rhabdomyolysis | 6 |
| Lack of medical history | 43 (31%) |
| Known hyperkalemia | 11 (8%) |
| Neuromuscular disease | 11 (8%) |
Common sedative agents used:
- Etomidate: 464 patients (89%), mean dose 0.29 mg/kg
- Midaolam: 12 patients(2%), mean dose 0.09 mg/kg
- Obtunded--no sedative used: 15 patients (3%)
- No sedation recorded: 14 patients (2%)
Criticisms & Further Discussion
- Onset of paralysis was only directly measured in 30-40% patients, with the rest being estimated by the person intubating
- While estimated times were very similar to measured times (within 4 seconds), this introduces a potential for recall bias and inaccuracy of onset timing
- As no specific inclusion or exclusion criteria were given, physicians could hand-pick patients to include in the study, introducing the possibility for selection bias.
- Patients were not randomized, and physicians were not blinded to medication choice.
- The subjective satisfaction score may be biased
- Other new non-depolarizing agents, in addition to rocuronium, should be considered in future studies for use in the ED