Marsch SC, Steiner L, Bucher E, Pargger H, Schumann M, Aebi T, Hunziker PR, Siegemund M.; Crit Care. 2011 Aug 16;15(4):R199. [Epub ahead of print]
Introduction: Succinylcholine and rocuronium are widely used to facilitate rapid sequence induction (RSI) intubation in intensive care. Concerns relate to side effects of succinylcholine and to a slower onset and inferior intubation conditions associated with rocuronium. So far succinylcholine and rocuronium have not been compared in an adequately powered randomized trial in intensive care. Accordingly, the aim of the present study was to compare the incidence of hypoxemia after rocuronium or succinylcholine in critically ill patients requiring an emergent RSI.
Methods: This is a prospective randomized controlled single-blind trial conducted from 2006 to 2010 at the University Hospital of Basel. Participants were 401 critically ill patients requiring emergent RSI. Patients were randomized to receive 1mg/kg succinylcholine or 0.6mg/kg rocuronium for neuromuscular blockade. The primary outcome was the incidence of oxygen desaturations defined as a decrease in oxygen saturation [greater than or equal to] 5%, assessed by continuous pulse oxymetry, at any time between the start of the induction sequence and 2 min after the completion of the intubation. A severe oxygen desaturation was defined as a decrease in oxygen saturation [greater than or equal to] 5% leading to a saturation value of [less than or equal to] 80%.
Results: There was no difference between succinylcholine and rocuronium regarding oxygen desaturations (succinylcholine 73/196; rocuronium 66/195; P = 0.67); severe oxygen desaturations (succinylcholine 20/196; rocuronium 20/195; P = 1.0); and extent of oxygen desaturations (succinylcholine -14 +/- 12%; rocuronium -16 +/- 13%; P = 0.77). The duration of the intubation sequence was shorter after succinycholine than after rocuronium (81 +/- 38 sec versus 95 +/- 48 sec; P = 0.002). Intubation conditions (succinylcholine 8.3 +/- 0.8; rocuronium 8.2 +/- 0.9; P = 0.7) and failed 1st intubation attempts (succinylcholine 32/200; rocuronium 36/201; P = 1.0) did not differ between the groups.
Conclusions: In critically ill patients undergoing emergent RSI, incidence and severity of oxygen desaturations, the quality of intubation conditions, and incidence of failed intubation attempts did not differ between succinylcholine and rocuronium.
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