Billups Kelsey, Larrimore Ashley, Li Junan, Werman Howard, Shirk Mary Beth
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH.
Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH; The Center for Emergency Medical Services, The Ohio State University Wexner Medical Center, Columbus, OH.
Air Med J. 2019 Jan-Feb;38(1):39-44. doi: 10.1016/j.amj.2018.09.006. Epub 2018 Oct 25.
The aim of this study was to evaluate the difference in the time to postintubation sedation between patients receiving etomidate and either succinylcholine or rocuronium in the prehospital setting.
Patients who received rapid sequence intubation medications from transport service personnel and were subsequently intubated were included. The critical care transport agency operates 8 helicopter- and 3 ground-based emergency medical service units.
This retrospective cohort study compared the time to the first sedative in patients intubated with etomidate and succinylcholine versus etomidate and rocuronium. Enrollment of 64 patients per arm was needed to achieve 80% power with a 2-tailed alpha of 0.05.
Sixty-four and 38 patients received succinylcholine or rocuronium, respectively. The median time to postetomidate sedation was 10 (range, 5.0-16.0) and 13.5 (range, 7.0-20.8) minutes for succinylcholine and rocuronium patients, respectively (P = .13). Given the average duration of effect of etomidate, succinylcholine, and rocuronium, 0 (0%) succinylcholine versus 33 (86.8%) rocuronium patients were found to be at risk of wakeful paralysis.
This study suggests rocuronium's long duration of effect puts patients at risk for wakeful paralysis once the short effects of etomidate have subsided.
本研究旨在评估在院前环境中接受依托咪酯与琥珀酰胆碱或罗库溴铵的患者在插管后镇静时间上的差异。
纳入从转运服务人员处接受快速顺序插管药物并随后进行插管的患者。重症监护转运机构运营8个直升机和3个地面紧急医疗服务单元。
这项回顾性队列研究比较了接受依托咪酯和琥珀酰胆碱插管的患者与接受依托咪酯和罗库溴铵插管的患者首次使用镇静剂的时间。每组需要纳入64例患者，以在双侧α为0.05的情况下达到80%的检验效能。
分别有64例和38例患者接受了琥珀酰胆碱或罗库溴铵。接受琥珀酰胆碱和罗库溴铵的患者在依托咪酯给药后镇静的中位时间分别为10（范围5.0 - 16.0）分钟和13.5（范围7.0 - 20.8）分钟（P = 0.13）。考虑到依托咪酯、琥珀酰胆碱和罗库溴铵的平均作用持续时间，发现0例（0%）接受琥珀酰胆碱的患者与33例（86.8%）接受罗库溴铵的患者有清醒性麻痹风险。
本研究表明，一旦依托咪酯的短效作用消退，罗库溴铵的长效作用会使患者面临清醒性麻痹的风险。
