James Priano, PharmD
Clinical Pharmacy Specialist - Emergency Medicine
AdventHealth Orlando
Orlando, Florida
Disclosure information not submitted.
Krista Dumkow, PharmD, BCPS
Clinical Pharmacy Specialist - Emergency Medicine
Memorial Hospital West, United States
Disclosure information not submitted.
Title: Time to Analgosedation following Rapid Sequence Intubation in Mechanically Ventilated Adults
Introduction: Patients who receive rocuronium during a rapid sequence intubation (RSI) experience delays in the initiation of postintubation analgosedation potentially due to the long duration of action of rocuronium. A delay in analgosedation has been associated with an increased incidence of paralysis without adequate sedation. While previous studies placed emphasis on time to continuous sedation, an evaluation on time to both analgesia and sedation postintubation is necessary to assess the shift in postintubation care to analgosedation. The purpose of this study is to compare the time it takes to initiate analgosedation in mechanically ventilated patients who received succinylcholine versus rocuronium and examine the impact of potential delays.
Methods: This was a retrospective, single-centered, cohort study of patients who received succinylcholine (n = 71) versus rocuronium (n = 69) for RSI. The primary outcome was the time between the administration of the paralytic agent and initiation of post-intubation analgosedation.
Results: Baseline characteristics were similar between groups. Significantly more succinylcholine patients received propofol post-intubation (51% vs. 43%; p = 0.001), while more rocuronium patients received midazolam post-intubation (6.4% vs. 12.9%; p = 0.04). The time to analgesia between succinylcholine and rocuronium was 31 minutes (20 – 102.5) vs. 54 minutes (15 – 184; p =0.82), and the time to sedation was 12 minutes (7.5 – 23) and 15 minutes (9 – 32), respectively (p = 0.19). There were no significant differences in secondary endpoints including time to goal Richmond Agitation-Sedation Scale (RASS) scores and Critical Pain Observation Tool (CPOT) scores, duration of mechanical ventilation, intensive care unit (ICU) and hospital length of stay (LOS), and 30-day mortality.
Conclusion: Patients who received rocuronium for paralysis during RSI experienced longer delays in analgesia as opposed to patients receiving succinylcholine. This creates the potential for the patient who receives rocuronium to be paralyzed without adequate analgosedation for post-intubation management.