Johnson Eric G, Meier Alex, Shirakbari Alicia, Weant Kyle, Baker Justice Stephanie
Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.
J Emerg Med. 2015 Jul;49(1):43-9. doi: 10.1016/j.jemermed.2014.12.028. Epub 2015 Mar 19.
Rapid sequence intubation (RSI) involves a rapidly acting sedative plus a neuromuscular blocking agent (NMBA) to facilitate endotracheal intubation. Rocuronium and succinylcholine are NMBAs commonly used in RSI with drastically different durations of action.
Evaluate whether patients receiving RSI with a longer-acting NMBA had a greater delay in sedation or analgesia than patients that received a short-acting NMBA.
This was a retrospective review of patients presenting to the emergency department requiring endotracheal intubation. Exclusions included age < 18 years, pregnancy, prior intubation, and contraindication to sedation and analgesia. Primary endpoint was time to continuous sedation or analgesia after RSI in patients receiving rocuronium or succinylcholine. Secondary endpoints included hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), and impact of an emergency medicine pharmacist (EPh).
A total 106 patients met inclusion criteria, 76 patients receiving rocuronium and 30 receiving succinylcholine. Mean time to sedation or analgesia was longer in the rocuronium group when compared to the succinylcholine group at 34 ± 36 min vs. 16 ± 21 min (p = 0.002). In the presence of an EPh, the mean time to sedation or analgesia was 20 ± 21 min, vs. 49 ± 45 min (p < 0.001). Time spent on ventilator, HLOS, and ICU LOS were not significantly different between groups.
Patients receiving rocuronium in RSI had a significantly longer time to sedation or analgesia when compared to patients receiving succinylcholine. The presence of an EPh significantly decreased the time to administration of sedation or analgesia after RSI.
快速顺序诱导插管（RSI）包括使用起效迅速的镇静剂加神经肌肉阻滞剂（NMBA）以利于气管插管。罗库溴铵和琥珀酰胆碱是RSI中常用的NMBA，其作用持续时间差异很大。
评估接受长效NMBA进行RSI的患者与接受短效NMBA的患者相比，在镇静或镇痛方面是否有更长的延迟。
这是一项对到急诊科需要气管插管患者的回顾性研究。排除标准包括年龄<18岁、妊娠、既往插管以及镇静和镇痛的禁忌症。主要终点是接受罗库溴铵或琥珀酰胆碱的患者RSI后达到持续镇静或镇痛的时间。次要终点包括住院时间（HLOS）、重症监护病房住院时间（ICU LOS）以及急诊医学药师（EPh）的影响。
共有106例患者符合纳入标准，76例接受罗库溴铵，30例接受琥珀酰胆碱。与琥珀酰胆碱组相比，罗库溴铵组达到镇静或镇痛的平均时间更长，分别为34±36分钟和16±21分钟（p = 0.002）。在有EPh的情况下，达到镇静或镇痛的平均时间为20±21分钟，而无EPh时为49±45分钟（p < 0.001）。两组之间在呼吸机使用时间、HLOS和ICU LOS方面无显著差异。
与接受琥珀酰胆碱的患者相比，接受罗库溴铵进行RSI的患者达到镇静或镇痛的时间明显更长。EPh的存在显著缩短了RSI后给予镇静或镇痛的时间。
