Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
Acad Emerg Med. 2011 Jan;18(1):10-4. doi: 10.1111/j.1553-2712.2010.00954.x. Epub 2010 Dec 23.
The objective was to determine the effect of paralytic type and dose on first-attempt rapid sequence intubation (RSI) success in the emergency department (ED).
This was a retrospective evaluation of information collected prospectively in a quality improvement database between July 1, 2007, and October 31, 2008. Information regarding all intubations performed in a tertiary care ED was recorded in this database. All RSI performed using succinylcholine or rocuronium were included. Logistic regression was used to analyze the effect of paralytic type and dosing, as well as age, sex, body mass index, physician experience, device type, and presence of difficult airway predictors on first attempt RSI success.
A total of 327 RSI were included in the final analyses. All patients received etomidate as the induction sedative and were successfully intubated. Of these, 113 and 214 intubations were performed using succinylcholine and rocuronium, respectively. The rate of first-attempt intubation success was similar between the succinylcholine and rocuronium groups (72.6% vs. 72.9%, p=0.95). Median doses used for succinylcholine and rocuronium were 1.65 mg/kg (interquartile range [IQR]=1.26-1.95 mg/kg) and 1.19 mg/kg (IQR=1-1.45 mg/kg), respectively. In the univariate logistic regression analyses, variables predictive of first-attempt intubation success were laryngeal view (more success if Grade 1 or 2 compared to Grade 3 or 4 of the Cormack-Lehane classification, odds ratio [OR] =55.18, 95% confidence interval [CI]=18.87 to 161.39), intubation device (less success if direct laryngoscopy, OR=0.57, 95% CI=0.34 to 0.96), and presence of a difficult airway predictor (OR=0.55, 95% CI=0.31 to 0.99). In the multivariate analysis, the only variable predictive of first-attempt intubation success was laryngeal view.
Succinylcholine and rocuronium are equivalent with regard to first-attempt intubation success in the ED when dosed according to the ranges used in this study.
旨在确定在急诊科（ED）中，麻痹类型和剂量对首次尝试快速序列插管（RSI）成功的影响。
这是对 2007 年 7 月 1 日至 2008 年 10 月 31 日期间前瞻性收集的质量改进数据库信息进行的回顾性评估。该数据库记录了三级护理 ED 中进行的所有插管信息。所有使用琥珀胆碱或罗库溴铵进行的 RSI 均包括在内。使用逻辑回归分析麻痹类型和剂量以及年龄、性别、体重指数、医生经验、设备类型和存在困难气道预测因素对首次尝试 RSI 成功的影响。
共有 327 例 RSI 纳入最终分析。所有患者均接受依托咪酯作为诱导镇静剂，并成功插管。其中，113 例和 214 例分别使用琥珀胆碱和罗库溴铵进行插管。琥珀胆碱和罗库溴铵组首次插管成功率相似（72.6%对 72.9%，p=0.95）。琥珀胆碱和罗库溴铵的中位剂量分别为 1.65mg/kg（四分位间距[IQR]=1.26-1.95mg/kg）和 1.19mg/kg（IQR=1-1.45mg/kg）。在单变量逻辑回归分析中，预测首次插管成功的变量包括喉镜检查（如果 Cormack-Lehane 分级为 1 级或 2 级，成功率更高，而如果为 3 级或 4 级，则为 55.18，95%置信区间[CI]=18.87 至 161.39）、插管设备（如果使用直接喉镜，成功率更低，OR=0.57，95%CI=0.34 至 0.96）和存在困难气道预测因素（OR=0.55，95%CI=0.31 至 0.99）。在多变量分析中，唯一预测首次插管成功的变量是喉镜检查。
在本研究剂量范围内，琥珀胆碱和罗库溴铵在 ED 中首次尝试插管的成功率相当。
