The following is a summary of “Post-intubation analgesia and sedation following succinylcholine vs. rocuronium in the emergency department,” published in the September 2023 issue of Emergency Medicine by Carlson, et al.
Succinylcholine and rocuronium are commonly used neuromuscular blocking agents (NMBAs) for rapid sequence intubation (RSI) in the emergency department (ED). Rocuronium has a significantly longer (∼30 min) action duration than succinylcholine (∼10 min). Prior research indicated that patients receiving rocuronium may experience longer delays to sedation following RSI and may be more prone to awareness with paralysis. For a retrospective, multicenter cohort study, researchers sought to evaluate the relationship between NMBA usage during RSI and post-intubation sedation and analgesia practices in the ED.
The study included adult patients aged 18 and older who received either succinylcholine or rocuronium during RSI in the ED between September 1, 2020, and August 31, 2021. Patients were excluded if they were intubated before arriving at the ED, had an out-of-hospital or in-ED cardiac arrest, or received sugammadex within 60 minutes of rocuronium administration. A total of 200 ED patients were included, with 100 receiving succinylcholine and 100 receiving rocuronium.
The study found no significant difference in the median time to initiate analgesia or sedation between the succinylcholine and rocuronium groups (10 vs. 8.5 minutes, P= 0.82). The Kaplan-Meier cumulative probabilities also did not differ significantly (P = 0.17). However, at 60 minutes post-RSI, patients receiving succinylcholine received significantly higher median doses of propofol (20 μg/kg/min vs. 10 μg/kg/min; P = 0.02) and fentanyl (100 μg vs. 84.2 μg; P = 0.02).
The study found no differences in the time to initiation of post-intubation sedation or analgesia in ED patients receiving succinylcholine compared to rocuronium. Nevertheless, differences were observed in the intensity of post-intubation regimens. Further investigation is required to assess the adequacy of sedation following RSI in the ED.