Impact of Paralytic Agent on Postintubation Sedation

Air Med J. 2019 Jan-Feb;38(1):39-44. doi: 10.1016/j.amj.2018.09.006. Epub 2018 Oct 25.


Objective: The 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.

Methods: This 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.

Results: Sixty-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.

Conclusions: This study suggests rocuronium's long duration of effect puts patients at risk for wakeful paralysis once the short effects of etomidate have subsided.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Air Ambulances*
  • Cohort Studies
  • Emergency Medical Services / methods*
  • Etomidate / administration & dosage*
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Intubation / methods*
  • Male
  • Middle Aged
  • Neuromuscular Depolarizing Agents / administration & dosage
  • Neuromuscular Nondepolarizing Agents / administration & dosage
  • Paralysis / chemically induced*
  • Retrospective Studies
  • Rocuronium / administration & dosage*
  • Succinylcholine / administration & dosage*
  • Time Factors


  • Hypnotics and Sedatives
  • Neuromuscular Depolarizing Agents
  • Neuromuscular Nondepolarizing Agents
  • Succinylcholine
  • Rocuronium
  • Etomidate