Abstract
I read with interest the review by Mallon et al. about the choice between rocuronium and succinylcholine for rapid sequence intubation (RSI) in the emergency department (ED) ( 1 Mallon W.K. Keim S.M. Shoenberger J.M. Walls R.M. Rocuronium vs. succinylcholine in the emergency department: a critical appraisal. J Emerg Med. 2009; 37: 183-188 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar ). I commend the authors on their review and assessment of the literature addressing this controversial topic. Rocuronium vs. Succinylcholine in the Emergency Department: A Critical AppraisalJournal of Emergency MedicineVol. 37Issue 2PreviewBackground: Two methods of paralysis are available for rapid sequence intubation (RSI) in the emergency department (ED): depolarizing agents such as succinylcholine, and non-depolarizing drugs such as rocuronium. Rocuronium is a useful alternative when succinylcholine is contraindicated. Contraindications to succinylcholine include allergy, history of malignant hyperthermia, denervation syndromes, and patients who are 24–48 h post burn or crush injury. Non-depolarizing drugs have the advantage of causing less pain due to post-paralysis myalgias. Full-Text PDF ResponseJournal of Emergency MedicineVol. 39Issue 3PreviewWe thank Dr. Strayer for his interest in our review and the topic in general (1). We agree with Dr. Strayer's central tenet, which is worth restating: “Emergency physicians are fortunate to have two safe and effective agents to use for RSI,” with different contraindications allowing rapid sequence intubation (RSI) to be tailored to the situation. We are not in agreement, however, with another basis of his subsequent discussion. Contrary to his assertion, cardiac arrest immediately after intubation actually is a rare event, and we would add that most of these are brady-asystolic arrests in critically ill hypoxic patients and are unlikely to be related to the choice of a particular neuromuscular blocking agent. Full-Text PDF
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