Rocuronium vs suxamethonium
March 5, 2011 by Cliff
Filed under All Updates, ICU, Resus
This short but punchy lecture by Reuben Strayer of the excellent Emergency Medicine Updates blog addresses some dogma and tells it like it is….
Rocuronium vs. Succinylcholine from reuben strayer on Vimeo.
Since making the video the article about oxygen desaturation time came out which contributes some further weight to the roc argument.
The way they’ve always taught this to Paramedics is that sux is good because they’ll come back around in a few minutes if you can’t tube them. Was interesting to hear that ED docs view it the other way around, it is BAD that they will come back around in a few minutes! I ran that by some of the medics at EMS Today and most were intrigued, but not surprised, by the different in views.
Thanks for an interesting presentation. I do have to disagree with your last point about roc ‘never’ causing problems. It is one of the most common (if not THE) most common causes of iatrogenic anaphylaxis in the operating room and this is clearly a significant problem.
I also don’t agree that it is always bad that sux has such a short duration. Better the relaxant wearing off that being stuck for 30mins with a difficult bag mask ventilation or worse a cant intubate, cant ventilate. Particularly for junior staff. Sugamadex isnt the answer to all intubation problems.
Whilst I agree the risks of sux induced hyperkalaemia are very real, esp in an emergency department where there isnt the luxury of a pre-op chat / thorough history I think its dangerous to label any of these drugs as never causing a problem.
Thanks.
christopher – I certainly do not speak for all emergency physicians. the dominant thinking on this question parallels your colleagues’, which is to say that lots of EPs choose sux thinking that the short duration of action is a benefit. I and what I guess is a minority of emerg docs disagree with this, for the reasons I mention in the lecture.
Em – you are of course correct that rocuronium, like all paralytics, can lead to anaphylaxis. there seems to be some regional variation in reporting rates. if a consensus emerges around serious reactions to roc significantly exceeding sux, that would certainly be an additional consideration when choosing a paralytic. At present, I would submit that rocuronium does not cause serious allergic reactions often enough to be relevant to emergency medicine practice.
reuben
http://bja.oxfordjournals.org/content/86/5/678.full
http://www.anesthesia-analgesia.org/content/101/3/819.full
http://gasexchange.com/questions/13/should-i-avoid-using-rocuronium-because-of-anaphylaxis
[...] being used on Resus.ME posts these days… nice work Cliff The ripper of the week concerns the Rocuronium vs suxamethonium debate — Cliff highlights this nice video summary by the brilliant Reuben Strayer of EM [...]
Interesting, thank you for the update. I was attending Dr. Levitan’s airway course when I read Cliff’s post and this same debate was brought up during the lecture. I look forward to more videos and blog posts from you.