Rocuronium dosing for rapid sequence intubation: A retrospective analysis in ED and ICU settings.

Area of Science:

• Anesthesiology and Critical Care Medicine
• Pharmacology and Therapeutics

Background:

• Rocuronium dosing strategies for rapid sequence intubation (RSI) are variable.
• Optimal rocuronium dosage for intubation success remains undetermined.
• Previous research suggests doses ≥1.2 mg/kg may improve intubation outcomes.

Purpose of the Study:

• To compare the effect of rocuronium doses (≤1.2 mg/kg vs. >1.2 mg/kg) on first attempt intubation success.
• To evaluate rocuronium's impact on secondary outcomes during RSI with video laryngoscopy in the ED and ICU.

Main Methods:

• Single-center retrospective chart review of adult patients undergoing RSI.
• Comparison of rocuronium doses ≤1.2 mg/kg versus >1.2 mg/kg.
• Primary outcome: successful first attempt intubation. Secondary outcomes: intubation attempts, time to intubation, mortality, length of stay.

Main Results:

• Doses >1.2 mg/kg were associated with significantly higher first attempt intubation success (100% vs. 89.5%).
• Higher rocuronium doses resulted in fewer mean intubation attempts (1 vs. 1.1).
• No significant differences in secondary outcomes or subgroup analyses (hypoperfusion, obesity).

Conclusions:

• Rocuronium doses >1.2 mg/kg significantly improve first attempt intubation success.
• No significant impact on secondary clinical outcomes or specific patient subgroups was observed.
• Further research is needed to refine evidence-based rocuronium dosing strategies for improved patient outcomes.