Is Succinylcholine Really Superior for RSI?
Background:
Intubation is arguably the most important procedure performed by Emergency Physicians (EPs). Ideally, it would be performed successfully on the first attempt each and every time, but this of course cannot always be the case. Rapid Sequence Intubation (RSI) has become the preferred method for emergency intubations, as it improves visualization of the vocal cords, and decreases complications such as aspiration and increased intracranial pressure. Succinylcholine, a depolarizing agent, is the most widely utilized paralytic due to its rapid onset and short half-life. However, there are certain circumstances in which succinylcholine is contraindicated, including suspected hyperkalemia, known prior adverse reactions, concern for head injury, neuromuscular disease, or spinal cord injury. Rocuronium, a non-depolarizing agent with a considerably longer half-life, is frequently used in these situations.
Prior studies evaluated by the Cochrane review suggest succinylcholine produces superior intubation conditions when compared to rocuronium.[1]However, there is concern that succinylcholine's advantage...