title: Comparison of rocuronium and succinylcholine on postintubation sedative and analgesic dosing in the emergency department.
abstract: OBJECTIVE
  Rocuronium and succinylcholine are both commonly used neuromuscular blockers for rapid sequence intubation in the emergency department (ED). The objective of this study was to determine if patients who receive rocuronium are more likely to receive lower doses of postintubation sedatives and analgesics compared with patients who receive succinylcholine.
  
  
  METHODS
  This was a retrospective cohort study carried out in a tertiary, academic ED. Consecutive adult patients, who were intubated using etomidate for induction of sedation, were included. Patients were categorized on the basis of whether they received (a) rocuronium or (b) succinylcholine for paralysis. The dosing of postintubation sedative and analgesic infusions were compared 30 min after initiation between the two groups.
  
  
  RESULTS
  A total of 254 patients were included in the final analysis (rocuronium=127 and succinylcholine=127). In the overall cohort, 90.2% (n=229) of patients were administered a sedative postintubation in the ED. Most of these patients were initiated on propofol infusions. The mean propofol infusion rate at 30 min was 30±23 mcg/kg/min in the rocuronium group and 42±24 mcg/kg/min in the succinylcholine group (P=0.002). A total of 42.5% of patients (n=108) received an analgesic infusion (all patients received fentanyl). The mean fentanyl infusion rate at 30 min was 0.65±0.55 and 0.86±0.49 mcg/kg/h in the rocuronium and succinylcholine groups, respectively (P=0.041).
  
  
  CONCLUSIONS
  Patients who receive rocuronium are more likely to receive lower doses of sedative and analgesic infusions after intubation. This may place them at risk of being awake under paralysis.
authors.affiliation: aDepartment of Emergency Medicine, College of Medicine bDepartment of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Korinek
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Thomas
authors.forename: Luke A
authors.initials: LA
authors.lastname: Goddard
authors.forename: Alexander E
authors.initials: AE
authors.lastname: St John
authors.forename: John C
authors.initials: JC
authors.lastname: Sakles
authors.forename: Asad E
authors.initials: AE
authors.lastname: Patanwala
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000732:Androstanols / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D012189:Retrospective Studies; D000077123:Rocuronium; D013390:Succinylcholine / Q000008:administration & dosage* / Q000009:adverse effects; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000732:Androstanols; D006993:Hypnotics and Sedatives; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D013390:Succinylcholine; D000077123:Rocuronium