Impact of Paralytic Agent on Postintubation Sedation

Abstract

ObjectiveThe 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. 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. MethodsThis 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. ResultsSixty-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. ConclusionsThis study suggests rocuronium's long duration of effect puts patients at risk for wakeful paralysis once the short effects of etomidate have subsided.