Department of Pharmacy, Cleveland Clinic, Cleveland, OH, United States of America; Emergency Services Institute, Cleveland Clinic, Cleveland, OH, United States of America; Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America; Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America.
Department of Pharmacy, Cleveland Clinic, Cleveland, OH, United States of America; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America.
Am J Emerg Med. 2023 Sep;71:99-103. doi: 10.1016/j.ajem.2023.06.017. Epub 2023 Jun 16.
Succinylcholine and rocuronium are the most commonly utilized neuromuscular blocker agents (NMBAs) for rapid sequence intubation (RSI) in the emergency department (ED). The duration of action of rocuronium is significantly longer (∼30 min) compared to succinylcholine (∼10 min) and previous studies have shown that patients receiving rocuronium are more likely to have longer time to sedation initiation following RSI. Furthermore, patients receiving rocuronium may be more likely to experience awareness with paralysis than those receiving succinylcholine. The primary goal for this study was to evaluate the association between NMBA use during RSI and post-intubation sedation and analgesia practices in the ED.
This was a retrospective, multicenter cohort study including patients 18 years and older that received succinylcholine or rocuronium during RSI in the ED between September 1, 2020 and August 31, 2021. Patients were excluded if they were intubated prior to ED arrival, experienced an out-of-hospital or in ED cardiac arrest, or received sugammadex within 60 min of rocuronium administration. Patients were screened in reverse chronological order until the targeted sample size was achieved and all data was abstracted from the electronic health record. The primary outcome was the time to initiation of analgesia or sedation. Secondary outcomes included dose of sedatives or analgesia administered at 30- and 60 min, and medications administered for post-intubation sedation or analgesia.
A total of 200 ED patients were included of which 100 received succinylcholine and 100 received rocuronium. There was no difference in the median time to initiation of analgesia or sedation between the succinylcholine and rocuronium groups (10 vs 8.5 min, p = 0.82) or in Kaplan-Meier cumulative probabilities (p = 0.17). At 60 min post-RSI, those receiving succinylcholine received significantly higher median doses of propofol (20 μg/kg/min vs. 10 μg/kg/min; p = 0.02) and fentanyl [100 μg vs. 84.2 μg; p = 0.02].
While no differences were observed in the time to initiation of post-intubation sedation or analgesia in ED patients receiving succinylcholine compared to rocuronium, differences in the intensity of post-intubation regimens was observed. Further investigation is needed to evaluate the adequacy of sedation following RSI in the ED.
琥珀酰胆碱和罗库溴铵是急诊科（ED）中进行快速序列插管（RSI）时最常使用的神经肌肉阻滞剂（NMBA）。罗库溴铵的作用持续时间明显长于琥珀酰胆碱（约 30 分钟），并且之前的研究表明，接受罗库溴铵的患者在 RSI 后开始镇静的时间更长。此外，接受罗库溴铵的患者比接受琥珀酰胆碱的患者更有可能在麻痹时出现意识。本研究的主要目标是评估 RSI 期间使用 NMBA 与 ED 中插管后镇静和镇痛实践之间的关联。
这是一项回顾性、多中心队列研究，纳入 2020 年 9 月 1 日至 2021 年 8 月 31 日期间在 ED 接受 RSI 时接受琥珀酰胆碱或罗库溴铵的 18 岁及以上患者。如果患者在到达 ED 之前已插管、发生院外或 ED 心搏骤停或在罗库溴铵给药后 60 分钟内接受舒更葡糖，则将其排除在外。患者按逆时间顺序进行筛选，直到达到目标样本量，并从电子健康记录中提取所有数据。主要结局是开始镇痛或镇静的时间。次要结局包括 30 分钟和 60 分钟时给予的镇静剂或镇痛药剂量，以及用于插管后镇静或镇痛的药物。
共纳入 200 名 ED 患者，其中 100 名接受琥珀酰胆碱，100 名接受罗库溴铵。琥珀酰胆碱组和罗库溴铵组开始镇痛或镇静的中位时间无差异（10 分钟与 8.5 分钟，p=0.82）或 Kaplan-Meier 累积概率无差异（p=0.17）。在 RSI 后 60 分钟时，接受琥珀酰胆碱的患者接受的丙泊酚中位剂量明显更高（20μg/kg/min 与 10μg/kg/min；p=0.02）和芬太尼[100μg 与 84.2μg；p=0.02]。
尽管与罗库溴铵相比，接受琥珀酰胆碱的 ED 患者插管后镇静或镇痛的开始时间无差异，但观察到插管后方案的强度存在差异。需要进一步研究来评估 ED 中 RSI 后镇静的充分性。
