Update: Does Rocuronium Create Better Intubating Conditions Than Succinylcholine for Rapid Sequence Intubation?
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Administering too small a dose (<1.0 mg/kg) of rocuronium, particularly in low-flow states, will result in inadequate intubating conditions and a larger dose is recommended (1.2-1.6 mg/kg).
“administering too small a dose (<1.0 mg/kg) of rocuronium, particularly in low-flow states, will result in inadequate intubating conditions and a larger dose is recommended (1.2-1.6 mg/kg).101,102”
From Airway Management in Trauma (2018) · cites this paper as [102]
The Commentary (page not provided) says rocuronium dose may affect intubating conditions and reports that succinylcholine produced better conditions at rocuronium doses of 0.6–0.7 mg/kg. It does not say that every dose below 1.0 mg/kg causes inadequate conditions: it found no difference at 0.9–1.0 mg/kg. It does not address low-flow states or recommend 1.2–1.6 mg/kg. (LLM, conf=0.88)
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Research works printed but not linked: 7
- Editor's Note: This is a clinical synopsis, a regular feature of the Annals' Systematic Review Snapshots (SRS) series. The source for this systematic review snapshot is: Tran DT, Newton EK, Mount VA, et al. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2015;(10):CD002788. http://dx. doi.org/10.1002/14651858. CD002788.pub3. · DOI · Paper page
- Magorian T, Flannery KB, Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology. 1993;79:913-918.
- Martyn JA, Richtsfeld M. Succinylcholine- induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology. 2006;104: 158-169.
- Patanwala AE, Erstad BL, Roe DJ, et al. Succinylcholine is associated with increased mortality when used for rapid sequence intubation of severely brain injured patients in the emergency department. Pharmacotherapy. 2016;36:57-63.
- Patanwala AE, Stahle SA, Sakles JC, et al. Comparison of succinylcholine and rocuronium for first-attempt intubation success in the emergency department. Acad Emerg Med. 2011;18:10-14.
- Brown CA, Bair AE, Pallin DJ, et al. Techniques, success, and adverse events of emergency department adult intubations. Ann Emerg Med. 2015;65:363-370.
- Marsch SC, Steiner L, Bucher E, et al. Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial. Crit Care. 2011;15:R199.
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Kovacs, G., & Sowers, N. (2018) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2017.08.006 · Cited by 115 · see citing works
- Authors
- Welch, J. L., & Seupaul, R. A.
- Affiliations
- Indiana University School of Medicine (US)
- University of Arkansas for Medical Sciences (US)
- ORCID
- Welch, Julie L.
- Venue
- Annals of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2017-05
- Volume
- 69
- Issue
- 5
- Pages
- e55-e56
- ISSN
- 0196-0644 (ISSN-L)
- OpenAlex
- W2548494754
- Cited by
- 11
- References
- 0
- Citations by year
- 2026: 2 · 2024: 1 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 1 · 2017: 3
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annals of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- rocuronium, succinylcholine, rapid sequence intubation, emergency intubation, intubating conditions, neuromuscular blocking agents, airway management, endotracheal intubation, emergency airway management, emergency medical services, prehospital care, pediatric airway management, intubation complications, intubation time, intubation success
- MeSH terms
- Rocuronium, Androstanols, Neuromuscular Nondepolarizing Agents, Humans, Intubation, Intubation, Intratracheal, Neuromuscular Depolarizing Agents, Succinylcholine
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