title: Accuracy of rapid sequence intubation medication dosing in obese patients intubated in the ED.
abstract: OBJECTIVE
  There are limited data regarding appropriateness of sedative and paralytic dosing of obese patients undergoing rapid sequence intubation (RSI) in the emergency department. The goal of this study was to compare rates of appropriate succinylcholine and etomidate doses in obese and nonobese patients.
  
  
  METHODS
  Retrospective review using a database of endotracheally intubated patients using RSI in an urban, tertiary care academic emergency department, from November 2009 to June 2011. Dosing for succinylcholine and etomidate was calculated as milligrams per kilogram of total body weight (TBW) for each patient, defining appropriate dosing as succinylcholine 1-1.5 mg/kg TBW and etomidate 0.2-0.4 mg/kg TBW. Logistic regression analysis was used to estimate the association between appropriate dosing and World Health Organization body mass index classification.
  
  
  RESULTS
  A total of 440 patients were included in the study, 311 (70.7%) classified as nonobese and 129 (29.3%) as obese. two hundred thirty-three (56%) received an inappropriate succinylcholine dose and 107 (24%) received an inappropriate etomidate dose. Obese patients were more likely to be underdosed with succinylcholine (odds ratio [OR], 63.7; 95% confidence interval [CI], 17.8-228.1) and etomidate (OR, 178.3; 95% CI, 37.6-844.7). Nonobese patients were more likely to be overdosed with succinylcholine (OR, 62.5; 95% CI, 17.9-250) and etomidate (OR, 166.7; 95% CI, 37.0-1000).
  
  
  CONCLUSIONS
  Obese patients were more likely to be underdosed during RSI compared with nonobese patients, whereas nonobese patients were more likely to be overdosed with RSI medications. Most obese and nonobese patients were inappropriately dosed with RSI medications, suggesting that physicians are not dosing these medications based on weight.
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC.
authors.forename: Rahul
authors.initials: R
authors.lastname: Bhat
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC.
authors.forename: Maryann
authors.initials: M
authors.lastname: Mazer-Amirshahi
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC.
authors.forename: Christie
authors.initials: C
authors.lastname: Sun
authors.affiliation: Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Janelle
authors.initials: J
authors.lastname: Vaughns
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC.
authors.forename: Maria
authors.initials: M
authors.lastname: Dynin
authors.affiliation: Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, MD.
authors.forename: Eshetu
authors.initials: E
authors.lastname: Tefera
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC.
authors.forename: Daryn
authors.initials: D
authors.lastname: Towle
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Munish
authors.initials: M
authors.lastname: Goyal
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D005045:Etomidate / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007442:Intubation, Intratracheal; D016015:Logistic Models; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D013390:Succinylcholine / Q000008:administration & dosage*
chemical_list: D006993:Hypnotics and Sedatives; D013390:Succinylcholine; D005045:Etomidate