In the emergency department at Hennepin County Medical Center, succinylcholine has been used to assist difficult intubations since March 1, 1979. In this report, the first 48 cases are reviewed. In these 48 patients, complete relaxation allowing endotracheal intubation was achieved in 42. Forty of the 42 patients intubated suffered no adverse effects. One patient vomited, delaying intubation, and another developed transient asystole. Six of 48 patients were not successfully intubated after succinylcholine; five of these six subsequently required cricothyrotomy. Inadequate dose, improper technique of administration, foreign material obscuring airway, and idiosyncratic reactions were thought to be reasons for failure. When properly administered, succinylcholine can be used to facilitate difficult intubations in the emergency department with an acceptable incidence of adverse effects or failures.