The use of neuromuscular blocking agents in the emergency department to facilitate tracheal intubation in the trauma patient: help or hindrance?

J Crit Care. 1998 Mar;13(1):1-6. doi: 10.1016/s0883-9441(98)90022-3.


Purpose: The purpose of this study is to examine the relationship between the occurrence of a difficult intubation and (1) the use of neuromuscular blocking agents (NMB) and (2) the presence of airway injuries. It is a retrospective analysis of data from a trauma registry.

Materials and methods: Registry records of patients (n = 160) who required emergent endotracheal intubation or establishment of a surgical airway over a 3.5-year period in the emergency department were reviewed. Risk factors for difficult intubations were identified and analyzed using multivariate logistic regression analysis.

Results: NMB were used in 75% of patients requiring intubation. Fifteen percent of the intubations were considered difficult. No association was found between the presence of airway injuries and difficult intubations; however, the use of succinylcholine was associated with a lower risk of difficult intubations compared with intubations where a nondepolarizing NMB was used.

Conclusions: The use of succinylcholine may result in fewer difficult intubations in the trauma patient than when a nondepolarizing NMB is used. The presence of airway injuries did not appear to predispose to difficult intubations.

MeSH terms

  • Adult
  • Emergency Treatment*
  • Facial Injuries*
  • Female
  • Humans
  • Intubation, Intratracheal*
  • Male
  • Neuromuscular Depolarizing Agents / therapeutic use*
  • Neuromuscular Nondepolarizing Agents / therapeutic use*
  • Registries
  • Respiratory System / injuries*
  • Retrospective Studies
  • Succinylcholine / therapeutic use
  • Vecuronium Bromide / therapeutic use


  • Neuromuscular Depolarizing Agents
  • Neuromuscular Nondepolarizing Agents
  • Vecuronium Bromide
  • Succinylcholine