title: Rocuronium Versus Suxamethonium: A Survey of First-line Muscle Relaxant Use in UK Prehospital Rapid Sequence Induction.
abstract: BACKGROUND
  Prehospital anaesthesia in the United Kingdom (UK) is provided by Helicopter Emergency Medical Service (HEMS) and British Association for Immediate Care (BASICS), a road-based service. Muscle relaxation in rapid sequence induction (RSI) has been traditionally undertaken with the use of suxamethonium; however, rocuronium at higher doses has comparable intubating conditions with fewer side effects.
  
  
  OBJECTIVE
  The aim of this survey was to establish how many prehospital services in the UK are now using rocuronium as first line in RSI.
  
  
  METHODS
  An online survey was constructed identifying choice of first-line muscle relaxant for RSI and emailed to lead clinicians for BASICS and HEMS services across the UK. If rocuronium was used, further questions regarding optimal dose, sugammadex, contraindications, and difference in intubating conditions were asked.
  
  
  RESULTS
  A total of 29 full responses (93.5%) were obtained from 31 services contacted. Suxamethonium was used first line by 17 prehospital services (58.6%) and rocuronium by 12 (41.4%). In 11 services (91.7%), a dose of 1 mg/kg of rocuronium was used, and in one service, 1.2 mg/kg (8.3%) was used. No services using rocuronium carried sugammadex. In five services, slower relaxation time was found using rocuronium (41.7%), and in seven services, no difference in intubation conditions were noted (58.3%). Contraindications to rocuronium use included high probability of difficult airway and anaphylaxis.
  
  
  CONCLUSIONS
  Use of rocuronium as first-line muscle relaxant in prehospital RSI is increasing. Continued auditing of practice will ascertain which services have adopted change and identify if complications of failed intubation increase as a result.
authors: 1Anaesthetic Department,Royal Alexandra Hospital,Paisley,United Kingdom.
authors: Emma L
authors: EL
authors: Hartley
authors: 2Emergency Department,Forth Valley Royal Hospital,Larbert,United Kingdom.
authors: Roger
authors: R
authors: Alcock
mesh_terms: D000732:Androstanols / Q000008:administration & dosage / Q000627:therapeutic use*; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000077123:Rocuronium; D013390:Succinylcholine / Q000008:administration & dosage / Q000627:therapeutic use*; D006113:United Kingdom
chemical_list: D000732:Androstanols; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D000077123:Rocuronium
keywords: BASICS British Association for Immediate Care Society; HEMS Helicopter Emergency Medical Service; RSI rapid sequence induction; UK United Kingdom; neuromuscular blocking agents