Vecuronium for Emergency Intubations?

Abstract

To the Editor: It has come to my attention that some prehospital rescue protocols now in place and being developed nationally include the use of vecuronium in the field as a first-line neuromuscular blocker. The use of a long- or intermediate-acting muscle relaxant under unpredictable tracheal intubating conditions is at best contraindicated and at worst lethal. As trained experts and clinicians, we anesthesiologists and anesthetists have a responsibility to our institutions and communities to provide advice and guidance to other health care professionals in airway management. In some instances, we have the opportunity to set standards for airway management protocols and algorithms, and we should emphasize the hazards of the use of such drugs and discourage their use. After all, we are usually the ones called for help when all other efforts at intubation have failed. Then the circumstances rarely are optimal for our success and don't allow back up with fiberoptics, jet ventilators, or other alternatives routinely available to us in the operating room. This letter is an effort to inform and alert our colleagues about this situation so that we can try to influence the quality of prehospital emergency care. This issue has an effect on us as professionals and potentially as patients as well. Yvonne E. Wagner, MD Thomas K. Clarke, MD Department of Anesthesiology Geisinger Clinic Danville, PA 17822