Comparison of Rocuronium and Succinylcholine for First-Attempt Intubation Success in the Emergency Department

IF 2.1 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Helen Y. Wang, Kaitlin E. Crowley, Lena K. Tran, Calvin A. Brown, Kaylee Marino
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引用次数: 0

Abstract

Background. Succinylcholine and rocuronium are the predominant neuromuscular blocking agents (NMBAs) used for rapid sequence intubation (RSI) in the emergency department (ED). Prior studies have found reduced first-attempt intubation success (FAIS) with rocuronium compared to succinylcholine. Recent large registry data have shown no difference in intubating conditions or FAIS. Objectives. The objective of this study was to compare FAIS rates for rocuronium and succinylcholine when used for RSI in a high-acuity academic ED. Methods. This was a single-center retrospective study. Patients were included if they received either succinylcholine or rocuronium for RSI in the ED from January 2016 to August 2020. The primary endpoint was FAIS. Subgroup analyses were performed evaluating the impact of weight-based dosing on FAIS for each agent, and multivariate analysis was conducted to evaluate the impact of baseline characteristics on the primary outcome. Results. There were 448 patients who received rocuronium and 183 patients who received succinylcholine. No difference was observed in unadjusted FAIS between patients receiving rocuronium (median weight-based dose: 1.22 mg/kg) or succinylcholine (median weight-based dose: 1.43 mg/kg) (361 (80.6%) vs. 150 (82.0%), p = 0.69). There were no differences in FAIS between the weight-based dose categories for rocuronium and for succinylcholine. Conclusions. These findings were consistent with those from recent studies indicating no difference in FAIS between rocuronium and succinylcholine, although the median dose of rocuronium used in this study was higher than traditionally recommended. Larger prospective studies are warranted to further evaluate the effect of weight-based paralytic dosing on FAIS.

Abstract Image

比较罗库洛宁和琥珀酰胆碱对急诊科首次尝试插管成功率的影响
背景。琥珀胆碱和罗库溴铵是急诊科(ED)用于快速顺序插管(RSI)的主要神经肌肉阻断剂(NMBA)。之前的研究发现,与琥珀胆碱相比,使用罗库溴铵会降低首次尝试插管的成功率(FAIS)。最近的大型登记数据显示,插管条件或 FAIS 没有差异。研究目的本研究旨在比较罗库溴铵和琥珀胆碱在高危急值学术急诊室用于 RSI 时的 FAIS 率。方法。这是一项单中心回顾性研究。从 2016 年 1 月到 2020 年 8 月,在急诊室接受琥珀胆碱或罗库溴铵治疗 RSI 的患者均被纳入研究范围。主要终点为 FAIS。研究人员进行了分组分析,评估基于体重的剂量对每种药物 FAIS 的影响,并进行了多变量分析,评估基线特征对主要结果的影响。结果共有 448 名患者接受了罗库溴铵治疗,183 名患者接受了琥珀胆碱治疗。接受罗库溴铵(基于体重的中位剂量:1.22 毫克/千克)或琥珀胆碱(基于体重的中位剂量:1.43 毫克/千克)治疗的患者在未经调整的 FAIS 方面无差异(361 例(80.6%)对 150 例(82.0%),P = 0.69)。罗库溴铵和琥珀胆碱在基于体重的剂量类别之间的 FAIS 没有差异。结论。尽管本研究中使用的罗库溴铵中位剂量高于传统推荐剂量,但这些结果与近期研究结果一致,表明罗库溴铵和琥珀胆碱的 FAIS 没有差异。有必要进行更大规模的前瞻性研究,以进一步评估基于体重的麻痹剂量对 FAIS 的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.10
自引率
5.00%
发文量
226
审稿时长
6 months
期刊介绍: The Journal of Clinical Pharmacy and Therapeutics provides a forum for clinicians, pharmacists and pharmacologists to explore and report on issues of common interest. Reports and commentaries on current issues in medical and pharmaceutical practice are encouraged. Papers on evidence-based clinical practice and multidisciplinary collaborative work are particularly welcome. Regular sections in the journal include: editorials, commentaries, reviews (including systematic overviews and meta-analyses), original research and reports, and book reviews. Its scope embraces all aspects of clinical drug development and therapeutics, including: Rational therapeutics Evidence-based practice Safety, cost-effectiveness and clinical efficacy of drugs Drug interactions Clinical impact of drug formulations Pharmacogenetics Personalised, stratified and translational medicine Clinical pharmacokinetics.
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