Muscle relaxant choices for rapid sequence induction

Rapid sequence induction (RSI) for intubation using neuromuscular blockade (NMB) is the most common method of achieving emergent tracheal intubation.(1) The ideal muscle relaxant for RSI would have four characteristics: a rapid onset to minimize the risk of aspiration and hypoxia, a rapid recovery to facilitate the return of ventilation if intubation proves difficult, minimal hemodynamic effects, and minimal systemic effects.(2) However, the ideal drug has yet to be found or created, so succinylcholine has been widely used for more than 40 years as a muscle relaxant in patients with full stomachs or who require emergent intubation.(3,4) Recently, rocuronium has received consideration as an alternative.(1,4) This article discusses both agents.