title: Impact of Rocuronium and Succinylcholine on Sedation Initiation After Rapid Sequence Intubation.
abstract: BACKGROUND
  Rapid sequence intubation (RSI) involves a rapidly acting sedative plus a neuromuscular blocking agent (NMBA) to facilitate endotracheal intubation. Rocuronium and succinylcholine are NMBAs commonly used in RSI with drastically different durations of action.
  
  
  OBJECTIVE
  Evaluate whether patients receiving RSI with a longer-acting NMBA had a greater delay in sedation or analgesia than patients that received a short-acting NMBA.
  
  
  METHODS
  This was a retrospective review of patients presenting to the emergency department requiring endotracheal intubation. Exclusions included age < 18 years, pregnancy, prior intubation, and contraindication to sedation and analgesia. Primary endpoint was time to continuous sedation or analgesia after RSI in patients receiving rocuronium or succinylcholine. Secondary endpoints included hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), and impact of an emergency medicine pharmacist (EPh).
  
  
  RESULTS
  A total 106 patients met inclusion criteria, 76 patients receiving rocuronium and 30 receiving succinylcholine. Mean time to sedation or analgesia was longer in the rocuronium group when compared to the succinylcholine group at 34 ± 36 min vs. 16 ± 21 min (p = 0.002). In the presence of an EPh, the mean time to sedation or analgesia was 20 ± 21 min, vs. 49 ± 45 min (p < 0.001). Time spent on ventilator, HLOS, and ICU LOS were not significantly different between groups.
  
  
  CONCLUSIONS
  Patients receiving rocuronium in RSI had a significantly longer time to sedation or analgesia when compared to patients receiving succinylcholine. The presence of an EPh significantly decreased the time to administration of sedation or analgesia after RSI.
authors: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.
authors: Eric G
authors: EG
authors: Johnson
authors: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.
authors: Alex
authors: A
authors: Meier
authors: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.
authors: Alicia
authors: A
authors: Shirakbari
authors: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.
authors: Kyle
authors: K
authors: Weant
authors: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.
authors: Stephanie
authors: S
authors: Baker Justice
mesh_terms: D000328:Adult; D000698:Analgesia; D000732:Androstanols / Q000008:administration & dosage*; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D010595:Pharmacists; D012121:Respiration, Artificial; D012189:Retrospective Studies; D000077123:Rocuronium; D013390:Succinylcholine / Q000008:administration & dosage*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D013390:Succinylcholine; D000077123:Rocuronium
keywords: analgesia; emergency medicine pharmacist; neuromuscular blocking agent; rapid sequence intubation; sedation