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Rocuronium Versus Suxamethonium: A Survey of First-line Muscle Relaxant Use in UK Prehospital Rapid Sequence Induction

Published online by Cambridge University Press:  28 January 2015

Emma L. Hartley  and
Roger Alcock
Emma L. Hartley*
Affiliation:
Anaesthetic Department, Royal Alexandra Hospital, Paisley, United Kingdom
Roger Alcock
Affiliation:
Emergency Department, Forth Valley Royal Hospital, Larbert, United Kingdom
*
Correspondence: Emma L. Hartley, MCEM Anaesthetic Department Royal Alexandra Hospital Paisley, PA29PN, United Kingdom E-mail [email protected]
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Abstract

Introduction

Prehospital anaesthesia in the United Kingdom (UK) is provided by Helicopter Emergency Medical Service (HEMS) and British Association for Immediate Care (BASICS), a road-based service. Muscle relaxation in rapid sequence induction (RSI) has been traditionally undertaken with the use of suxamethonium; however, rocuronium at higher doses has comparable intubating conditions with fewer side effects.

Hypothesis/Problem

The aim of this survey was to establish how many prehospital services in the UK are now using rocuronium as first line in RSI.

Methods

An online survey was constructed identifying choice of first-line muscle relaxant for RSI and emailed to lead clinicians for BASICS and HEMS services across the UK. If rocuronium was used, further questions regarding optimal dose, sugammadex, contraindications, and difference in intubating conditions were asked.

Results

A total of 29 full responses (93.5%) were obtained from 31 services contacted. Suxamethonium was used first line by 17 prehospital services (58.6%) and rocuronium by 12 (41.4%). In 11 services (91.7%), a dose of 1 mg/kg of rocuronium was used, and in one service, 1.2 mg/kg (8.3%) was used. No services using rocuronium carried sugammadex. In five services, slower relaxation time was found using rocuronium (41.7%), and in seven services, no difference in intubation conditions were noted (58.3%). Contraindications to rocuronium use included high probability of difficult airway and anaphylaxis.

Conclusion

Use of rocuronium as first-line muscle relaxant in prehospital RSI is increasing. Continued auditing of practice will ascertain which services have adopted change and identify if complications of failed intubation increase as a result.

HartleyEL , AlcockR . Rocuronium Versus Suxamethonium: A Survey of First-line Muscle Relaxant Use in UK Prehospital Rapid Sequence Induction. Prehosp Disaster Med. 2015;30(2):1-3.

Keywords

Emergency Medical Servicesgeneral anaesthesiaintratracheal intubationneuromuscular blocking agents
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 2 , April 2015 , pp. 184 - 186
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2015 

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References

1. British Association for Immediate Care. http://www.basics.org.uk/. Accessed May 5, 2013.Google Scholar
2. UK Helicopter Emergency Medical Service (HEMS). http://www.uk-hems.co.uk. Accessed May 5, 2013.Google Scholar
3. Orebaugh, SL. Succinylcholine: adverse effects and alternatives in emergency medicine. Am J Emerg Med. 1999;17(7):715-721.CrossRefGoogle ScholarPubMed
4. Larsen, PB, Hansen, EG, Jacobsen, LS, et al. Intubation conditions after rocuronium or succinylcholine for rapid sequence induction with alfentanil and propofol in the emergency patient. Eur J Anaesthesiol. 2005;22(10):748-753.CrossRefGoogle ScholarPubMed
5. McCourt, KC, Salmela, L, Mirakhur, RK, et al. Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia. Anaesthesia. 1998;53(9):867-871.CrossRefGoogle ScholarPubMed
6. Patanwala, AE, Stahle, SA, Sakles, JC, et al. Comparison of succinylcholine and rocuronium for first-attempt intubation success in the emergency department. Acad Emerg Med. 2011;18(1):10-14.CrossRefGoogle ScholarPubMed
7. Magorian, T, Flannery, KB, Miller, RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology. 1993;79(5):913-918.CrossRefGoogle ScholarPubMed
8. Perry, JJ, Lee, JS, Sillberg, VA, et al. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2008;(2):CD002788.Google ScholarPubMed
9. Andrews, JI, Kumar, N, van den Brom, RH, et al. A large simple randomized trial of rocuronium versus succinylcholine in rapid-sequence induction of anaesthesia along with propofol. Acta Anaesthesiol Scand. 1999;43(1):4-8.CrossRefGoogle ScholarPubMed
10. SurveyMonkey. http://www.surveymonkey.com. Accessed May 5, 2013.Google Scholar
11. Cowan, GM, Burton, F, Newton, A. Prehospital anaesthesia: a survey of current practice in the UK. Emerg Med J. 2012;29(2):136-140.CrossRefGoogle ScholarPubMed
12. Harris, T, Ellis, DY, Foster, L, et al. Cricoid pressure and laryngeal manipulation in 402 prehospital emergency anaesthetics: essential safety measure or a hindrance to rapid safe intubation? Resuscitation. 2010;81(7):810-816.CrossRefGoogle ScholarPubMed
13. European Medicine Agency. European Public Assessment Report for Sugammadex. EMEA/H/C/000885-II/0011. Annex III. http://www.emea.europa.eu/ema/. Accessed May 23, 2013.Google Scholar