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Impact of Paralytic Agent on Postintubation Sedation
Kelsey Billups1, Ashley Larrimore2, Junan Li3
1Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH.
Air Medical Journal
|February 4, 2019
Summary
In prehospital rapid sequence intubation, etomidate with succinylcholine showed a faster time to sedation than with rocuronium. Rocuronium use increased the risk of wakeful paralysis due to its longer duration of effect.
Area of Science:
- Emergency Medicine
- Pharmacology
- Critical Care
Background:
- Rapid sequence intubation (RSI) is a critical procedure in prehospital care.
- Sedation and neuromuscular blockade are key components of RSI.
- The choice of neuromuscular blocking agent can impact patient outcomes.
Purpose of the Study:
- To compare the time to postintubation sedation between etomidate-succinylcholine and etomidate-rocuronium combinations in the prehospital setting.
- To assess the risk of wakeful paralysis associated with these RSI medication regimens.
Main Methods:
- Retrospective cohort study involving patients undergoing prehospital RSI.
- Comparison of time to first sedative administration after etomidate use.
- Analysis of patient data from a critical care transport agency.
Main Results:
- Median time to post-etomidate sedation was 10 minutes for succinylcholine vs. 13.5 minutes for rocuronium (P=0.13).
- 86.8% of rocuronium patients were at risk of wakeful paralysis compared to 0% of succinylcholine patients.
- A significantly higher proportion of patients receiving rocuronium experienced wakeful paralysis.
Conclusions:
- The longer duration of action of rocuronium, compared to succinylcholine, poses a risk for wakeful paralysis after etomidate wears off.
- Consideration of neuromuscular blocking agent duration is crucial in prehospital RSI protocols.
- Etomidate-succinylcholine may offer a safer sedation profile in certain prehospital intubation scenarios.
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