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Related Experiment Videos

Muscle relaxant choices for rapid sequence induction.

M A Frakes1

  • 1LIFE STAR, Hartford Hospital, Hartford, CT, USA.

Air Medical Journal
|February 22, 2001
PubMed
Summary

Succinylcholine and rocuronium are common neuromuscular blocking agents for rapid sequence induction (RSI). This article compares these drugs, highlighting their pros and cons for emergent tracheal intubation in critical care settings.

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Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Rapid sequence induction (RSI) is the standard for emergent tracheal intubation, often utilizing neuromuscular blockade (NMB).
  • The ideal NMB agent for RSI offers rapid onset, quick recovery, and minimal systemic or hemodynamic effects.
  • Succinylcholine has been the long-standing agent of choice, despite its limitations, for patients requiring emergent intubation.

Purpose of the Study:

  • To compare succinylcholine and rocuronium as neuromuscular blocking agents for rapid sequence induction.
  • To evaluate the characteristics of each agent relevant to emergent tracheal intubation.
  • To discuss the current considerations for selecting an NMB agent in RSI.

Main Methods:

  • Review of existing literature on succinylcholine and rocuronium for RSI.
  • Discussion of pharmacokinetic and pharmacodynamic properties of both agents.
  • Analysis of clinical data and expert opinion regarding NMB selection in emergent intubation.

Main Results:

  • Succinylcholine offers rapid onset and offset but carries risks like hyperkalemia and prolonged paralysis in certain patients.
  • Rocuronium provides rapid onset and intermediate duration, with sugammadex as a reversal agent, but can cause anaphylaxis.
  • Neither agent perfectly meets all criteria for the ideal RSI muscle relaxant.

Conclusions:

  • Succinylcholine remains a widely used agent for RSI due to its rapid action, despite potential adverse effects.
  • Rocuronium is a viable alternative, particularly when rapid recovery is crucial and sugammadex is available.
  • The choice between succinylcholine and rocuronium depends on patient factors, clinical context, and clinician experience.

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