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Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review
D T T Tran1,2, E K Newton1, V A H Mount3
1Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa.
Anaesthesia
|June 28, 2017
Summary
Succinylcholine provides superior intubating conditions compared to rocuronium during rapid sequence intubation. This systematic review found succinylcholine more effective for both excellent and acceptable tracheal intubation, though evidence quality is moderate.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Pharmacology
Background:
- Rapid sequence intubation (RSI) is a critical procedure for airway management.
- Choosing the appropriate neuromuscular blocking agent is crucial for successful RSI.
- Rocuronium and succinylcholine are commonly used agents, each with distinct characteristics.
Purpose of the Study:
- To systematically review and compare the efficacy of rocuronium versus succinylcholine in achieving optimal intubating conditions during RSI.
- To evaluate the quality of evidence supporting the use of these agents in RSI.
Main Methods:
- Systematic review of randomized controlled trials and controlled clinical trials.
- Searched major databases including Cochrane CENTRAL, MEDLINE, and EMBASE.
- Included studies comparing rocuronium (≥0.6 mg/kg) and succinylcholine (≥1 mg/kg) for RSI, analyzing data from 50 studies with 4151 participants.
Main Results:
- Succinylcholine demonstrated superiority over rocuronium in achieving excellent intubating conditions (RR 0.86; 95% CI 0.81-0.92) and clinically acceptable conditions (RR 0.97; 95% CI 0.95-0.99).
- The advantage of succinylcholine was more pronounced when thiopental was used as the induction agent.
- Moderate quality of evidence due to detection bias and significant heterogeneity.
Conclusions:
- Succinylcholine remains a more effective agent than rocuronium for establishing optimal intubating conditions during rapid sequence intubation.
- Clinicians should consider the evidence and potential biases when selecting neuromuscular blocking agents for RSI.
- Further high-quality research may be needed to clarify optimal agent selection in specific patient populations or clinical scenarios.
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