Rocuronium versus succinylcholine for rapid sequence induction intubation

Abstract

Study characteristics We included in the review controlled trials from 1966 to February 2015 involving participants of all ages needing rapid intubation using rocuronium and succinylcholine. The minimum dose of rocuronium given was 0.6mg/kg and succinylcholine was 1mg/kg. We have combined the results of 50 trials, with a total of 4151 participants, which compared the e ectiveness of succinylcholine versus rocuronium on intubation conditions. No major side e ects from use of the drugs were reported. Key results We have found that rocuronium is slightly less e ective than succinylcholine for creating excellent and acceptable intubation conditions. Rocuronium should therefore only be used as an alternative to succinylcholine when it is known that succinylcholine should not be used and a more prolonged intubation is expected. Quality of evidence The level of evidence is of moderate GRADE due to imperfect study designs and varying techniques used across trials .

Our love-hate relationship with succinylcholine: Is sugammadex any better?

“…2,3 Because of its unique characteristics of rapid onset and short duration of muscle paralysis, succinylcholine enjoyed superiority over other muscle relaxants as the ''gold standard'' 4 for RSI by clinicians for more than half a century. 5 According to a survey conducted in several European countries and the United States, 6 the most desirable features of succinylcholine reported were rapid onset (88%), short duration (64%), and effective relaxation (61%). The thousands of succinylcholine-related papers published since the 1950s have generated an expansive body of literature, including discoveries extending beyond its immediate effects of muscle relaxation.…”

“…11,12 Fortunately, large doses of rocuronium (e.g., 1.2 mgÁkg -1 ) have been shown to have comparable onset times to succinylcholine in the setting of RSI. 5 The downside is that many clinicians are reluctant to administer such large doses due to the associated prolonged paralysis and apnea, particularly in patients whose lungs may be difficult to ventilate and oxygenate. So, the search continues for a replacement for succinylcholine.…”

“…While many reports indicate that, with appropriate dosing, succinylcholine and rocuronium have similar clinically acceptable intubation conditions and onset time, succinylcholine consistently produces better intubation conditions with higher satisfaction scores. 5 Furthermore, its low cost and ubiquitous nature make it an easy choice to reach for in the operating room. But we still hate it for its adverse effects.…”

“…2,3 En raison de ses propriétés uniques, soit un court délai d'action et une curarisation de courte durée, la succinylcholine a été préférée aux autres curares et considérée « l'étalon or » pour l'ISR par les cliniciens pendant plus d'un demi-siècle. 5 Selon un sondage réalisé dans plusieurs pays européens et aux É tats-Unis, 6 les caractéristiques les plus appréciées de la succinylcholine sont son délai d'action rapide (88 %), sa courte durée d'action (64 %), et l'efficacité de la relaxation obtenue (61 %). Les milliers d'articles portant sur la succinylcholine publiés depuis les années 1950 ont généré un corpus de littérature impressionnant, qui comprend des observations qui vont bien au-delà de ses effets immédiats de curarisation.…”

“…Bien que plusieurs comptes rendus indiquent que, lorsque bien dosés, la succinylcholine et le rocuronium procurent tous deux des conditions d'intubation et un délai d'action acceptables d'un point de vue clinique, la succinylcholine procure toujours de meilleures conditions d'intubation avec des scores de satisfaction plus élevés. 5 En outre, son faible coût et son omniprésence la rendent facile d'accès dans la salle d'opération. Néanmoins, nous la détestons tout de même en raison de ses effets secondaires.…”