Time to Sedation and Analgesia After Rapid Sequence Intubation in the Emergency Department

Rapid sequence intubation (RSI) is a common procedure within the Emergency Department. "Sedation gap"-the time between induction and post intubation sedation-has been associated with adverse outcomes. The aim of this study was to measure the median time to sedation or analgesia post intubation in adult patients within an Australian Emergency Department (ED). The secondary aim was to assess the difference in "sedation gap" among medical and trauma patient cohorts.

The retrospective study was conducted using data within a 12-month period at an Australian adult tertiary referral hospital emergency department. Data were sourced from an online airway registry and electronic medical records. Time to sedation or analgesia was summarised as median with interquartile range.

There were 158 patients included in the study. Overall median time to sedation was 7.5 min (IQR 4.0-14.0). This did not differ significantly between medical and trauma patient groups (8.0 min [IQR, 4-18 min] vs. 7.0 min [IQR, 4-13 min]). For induction of anaesthesia the main sedative agent was ketamine (n = 120, 75.9%) and paralytic agent rocuronium (n = 151, 95.6%). First attempt success rate was 95.6% (n = 151).

We observed a median time of 7.5 min between paralysis and administration of post-intubation sedation or analgesia within an Australian ED. Ongoing surveillance with strategies to minimise "sedation gap" is indicated.