The use of neuromuscular blocking agents in the emergency department to facilitate tracheal intubation in the trauma patient: help or hindrance?
OBJECTIVE
The purpose of this study is to examine the relationship between the occurrence of a difficult intubation and (1) the use of neuromuscular blocking agents (NMB) and (2) the presence of airway injuries. It is a retrospective analysis of data from a trauma registry.


METHODS
Registry records of patients (n = 160) who required emergent endotracheal intubation or establishment of a surgical airway over a 3.5-year period in the emergency department were reviewed. Risk factors for difficult intubations were identified and analyzed using multivariate logistic regression analysis.


RESULTS
NMB were used in 75% of patients requiring intubation. Fifteen percent of the intubations were considered difficult. No association was found between the presence of airway injuries and difficult intubations; however, the use of succinylcholine was associated with a lower risk of difficult intubations compared with intubations where a nondepolarizing NMB was used.


CONCLUSIONS
The use of succinylcholine may result in fewer difficult intubations in the trauma patient than when a nondepolarizing NMB is used. The presence of airway injuries did not appear to predispose to difficult intubations.
Vijayakumar
E
E
Department of Anesthesiology, University of Massachusetts Medical Center, Worcester 01655, USA.
Bosscher
H
H
Renzi
F P
FP
Baker
S
S
Heard
S O
SO
D000328:Adult; D004638:Emergency Treatment; D005151:Facial Injuries; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D009467:Neuromuscular Depolarizing Agents / Q000627:therapeutic use*; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use*; D012042:Registries; D012137:Respiratory System / Q000293:injuries*; D012189:Retrospective Studies; D013390:Succinylcholine / Q000627:therapeutic use; D014673:Vecuronium Bromide / Q000627:therapeutic use
D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D013390:Succinylcholine