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Analgosedative interventions after rapid sequence intubation with rocuronium in the emergency department
Emily Kilber1, Daniel H Jarrell2, John C Sakles3
1Department of Pharmacy, Maricopa Integrated Health System, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA; Department of Pharmacy Services, Banner - University Medical Center Tucson, 1501 N Campbell Ave, Tucson, AZ 85724, USA.
The American Journal of Emergency Medicine
|November 22, 2017
Summary
Rapid sequence intubation (RSI) using etomidate and rocuronium did not delay post-intubation analgesia and sedation. A pharmacy-led education program ensured timely analgosedative interventions after RSI.
Area of Science:
- Emergency Medicine
- Pharmacology
Background:
- Etomidate and rocuronium are commonly used for rapid sequence intubation (RSI).
- The duration of paralysis from rocuronium may exceed the sedation effects of etomidate.
- Post-intubation analgosedation management is critical for patient outcomes.
Purpose of the Study:
- To compare the number of analgosedative interventions early versus late post-RSI.
- To descriptively assess the time to the first analgosedative intervention.
Main Methods:
- Retrospective cohort study in an academic emergency department (ED).
- Included adult patients receiving etomidate and rocuronium for RSI post-pharmacy education.
- Primary outcome: number of analgosedative interventions (opioid/sedative initiation or infusion increase) at 0-30 min (early) vs. 60-90 min (late) post-RSI.
Main Results:
- 108 patients included; mean age 58 years; 57% male.
- Median of 2 early interventions (IQR 1-3) vs. 0 late interventions (IQR 0-1) (p<0.001).
- Median time to first analgosedative intervention was 7 minutes (IQR 3-13 min).
Conclusions:
- Rocuronium use for RSI in the ED did not result in delayed post-intubation sedation or analgesia.
- A pharmacy-led educational program was associated with timely analgosedative interventions.
Keywords:
Anesthesia and analgesiaAwarenessEmergency medical servicesHypnotics and sedativesIntubationNeuromuscular blocking agentsMore Related Videos
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