![]() ![]() A total of 20 papers were fully reviewed as they were found to most relevant to the paralytics being examined for adverse events in various patient populations. A third search using the search criteria of “adverse events,” “rapid sequence intubation,” and “vecuronium” resulted in 25 papers. A second search using the search criteria of “adverse events,” “rapid sequence intubation,” and “rocuronium” resulted in 57 papers. Using the search terms of “adverse events,” “rapid sequence intubation,” and “succinylcholine” there were 100 papers found. The difference in these two mechanisms accounts for the associated rise in serum potassium 0.05–1.0 mEq/L after succinylcholine administration.Ī literature search for comparisons of reported adverse events in patients undergoing RSI with succinylcholine compared to rocuronium/vecuronium was performed. Other classes of paralytics used in RSI function to compete with the native acetylcholine for the AChRs, resulting in paralysis secondary to lack of neuromuscular junction depolarization. Succinylcholine differs from other paralytics used in RSI in that succinylcholine binds to the AChR causing depolarization with an immediate resistance to repeated depolarization facilitating paralysis. ![]() Succinylcholine acts by binding nicotinic acetylcholine receptors (AChRs) that are located at the neuromuscular junction and cause depolarization at that junction. This is a retrospective review of data and only examines patterns of mortality associated with paralytic use to identify potential hypotheses for future prospective study. In this analysis, we examine 6 years of data from RSI events in our ED and ask whether the risk profile of succinylcholine utilization outweighs benefits when another class of paralytic agents is equally and readily available. The drug is still frequently used, likely secondary to a perceived decreased risk gained from a shorter half-life during high risk airway intubation compared to the nondepolarizing agents.Ĭurrently, the added benefits of the drug with a short half-life and the known risks of the same drug in patients that are likely to present to the emergency department (ED) (e.g., those that may have hyperkalemia) compared to the nondepolarizing class of agents, which have a longer half-life but less complex set of contraindications, remains unclear. Succinylcholine is used more often by most emergency medicine providers even though there are more known adverse events documented. Widely available choices include depolarizing (succinylcholine) or nondepolarizing agents (rocuronium and vecuronium). Rapid sequence intubation (RSI) usually involves the use of a paralytic agent. ![]()
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