Background: 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.
Clinical question: Can rocuronium replace succinylcholine as the paralytic of choice for RSI in the ED?
Evidence review: Four relevant studies were selected from an evidence search and a structured review performed.
Results: For the outcomes of clinically acceptable intubation conditions and time to onset, the two agents were not statistically significantly different. Succinylcholine seems to produce conditions that have higher satisfaction scores.
Conclusion: Succinylcholine remains the drug of choice for ED RSI unless there is a contraindication to its usage.