A comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients.
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.
Laurin
E G
EG
Division of Emergency Medicine, University of California, Davis, Medical Center, University of California, Davis, School of Medicine, Sacramento, CA, USA. eglaurin@ucdavis.edu
Sakles
J C
JC
Panacek
E A
EA
Rantapaa
A A
AA
Redd
J
J
D000732:Androstanols / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D009467:Neuromuscular Depolarizing Agents / Q000627:therapeutic use*; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D000077123:Rocuronium; D018709:Statistics, Nonparametric; D013390:Succinylcholine / Q000627:therapeutic use*
D000732:Androstanols; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D013390:Succinylcholine; D000077123:Rocuronium