Greater Sydney Area Helicopter Emergency Medical Service, NSW Ambulance, Sydney, New South Wales, Australia.
Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2022 Dec;34(6):892-897. doi: 10.1111/1742-6723.14008. Epub 2022 Jun 1.
Greater Sydney Area Helicopter Emergency Medical Service encouraged an increased dose of rocuronium for rapid sequence intubations (RSIs) from 1.5 mg/kg to 2.0 mg/kg from the end of 2017 in response to a number of inadequately paralysed patients identified by our airway audit processes. Subsequent protocol change incorporated 2.0 mg/kg rocuronium. This retrospective observational study was undertaken to see if doses over 1.5 mg/kg rocuronium were associated with a reduction in the number of inadequately paralysed patients.
Retrospective review of patient prehospital notes and airway database records from 2017 to 2018 for all cases using rocuronium for RSI. Primary outcome of interest was physician notes describing skeletal muscle activity at laryngoscopy. Patients with tissued vascular access were excluded. Dose of rocuronium, estimated patient actual weight and grade of laryngoscopy were recorded. Comparisons were made between rocuronium doses ≤1.5 mg/kg and >1.5 mg/kg by estimated weight.
From 211 patients receiving rocuronium ≤1.5 mg/kg, five cases were inadequately paralysed, compared with two cases from 384 patients receiving >1.5 mg/kg rocuronium.
Although there were fewer inadequately paralysed patients with rocuronium doses >1.5 mg/kg, this did not reach statistical significance, presumably because of the low event rate. Further investigation into rocuronium dose for RSI is warranted.
由于我们的气道审核流程发现了许多未能充分麻痹的患者，大悉尼地区直升机急救医疗服务机构于 2017 年底鼓励将罗库溴铵用于快速序贯插管 (RSI) 的剂量从 1.5mg/kg 增加至 2.0mg/kg。随后的方案变更纳入了 2.0mg/kg 罗库溴铵。本回顾性观察性研究旨在观察罗库溴铵剂量超过 1.5mg/kg 是否与减少未能充分麻痹的患者数量有关。
对 2017 年至 2018 年所有使用罗库溴铵进行 RSI 的患者的院前病历和气道数据库记录进行回顾性审查。主要观察指标是描述喉镜检查时骨骼肌活动的医生记录。排除有组织血管通路的患者。记录罗库溴铵剂量、估计患者实际体重和喉镜检查等级。通过估计体重比较罗库溴铵剂量≤1.5mg/kg 和>1.5mg/kg 组之间的差异。
在接受罗库溴铵≤1.5mg/kg 的 211 例患者中，有 5 例患者未能充分麻痹，而在接受>1.5mg/kg 罗库溴铵的 384 例患者中，有 2 例患者未能充分麻痹。
尽管罗库溴铵剂量>1.5mg/kg 的患者中未能充分麻痹的患者较少，但这并未达到统计学意义，可能是因为事件发生率较低。进一步研究罗库溴铵用于 RSI 的剂量是有必要的。
