title: Effect of paralytic type on time to post-intubation sedative use in the emergency department.
abstract: OBJECTIVE
  To determine the difference between rocuronium and succinylcholine with regard to post-intubation sedative initiation in the emergency department.
  
  
  METHODS
  This was a retrospective cohort study conducted in a tertiary care emergency department (ED) in the USA. Consecutive adult patients intubated in the ED using succinylcholine or rocuronium for paralysis were included. Data collected included patient demographics, vital signs, medications used post-intubation and times of drug administration. Patients were divided into two groups based on the type of paralytic used for rapid sequence intubation: (1) rocuronium or (2) succinylcholine. All patients received etomidate for induction of sedation. Time between intubation and post-intubation sedative use was compared between the two groups using an unpaired Student's t test.
  
  
  RESULTS
  A total of 200 patients were included in the final analyses (100 patients in each group). There were no significant differences between the groups with regard to patient demographics, vital signs or other baseline characteristics. After intubation, 77.5% (n=155) of patients were initiated on a sedative infusion of propofol (n=148) or midazolam (n=7). The remaining patients received sedation as bolus doses only. Mean time between intubation and post-intubation sedative use was significantly greater in the rocuronium group compared with the succinylcholine group (27 min vs 15 min, respectively; p<0.001).
  
  
  CONCLUSIONS
  Patients intubated with rocuronium had greater delays in post-intubation sedative initiation compared with succinylcholine.
authors.affiliation: Department of Surgery College of Medicine, University of Arizona Tucson, Arizona, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Watt
authors.forename: Albert
authors.initials: A
authors.lastname: Amini
authors.forename: Brittany R
authors.initials: BR
authors.lastname: Traylor
authors.forename: Richard
authors.initials: R
authors.lastname: Amini
authors.forename: John C
authors.initials: JC
authors.lastname: Sakles
authors.forename: Asad E
authors.initials: AE
authors.lastname: Patanwala
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000732:Androstanols / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage*; D012189:Retrospective Studies; D000077123:Rocuronium; D013390:Succinylcholine / Q000008:administration & dosage*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000732:Androstanols; D006993:Hypnotics and Sedatives; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D000077123:Rocuronium
keywords: anaesthesia - rsi