Rocuronium ≤1.5 mg/kg versus >1.5 mg/kg and inadequate paralysis in prehospital and retrieval intubation: A retrospective study
Clare Hayes-Bradley MBBS, BSc, Madelaine Tarrant MBChB, BSc
First published: 01 June 2022
https://doi.org/10.1111/1742-6723.14008
Findings
High dose Rocuronium leads to lower rates of inadequate relaxation
Bottom line
To achieve rapid and adequate relaxation for laryngoscopy up to 2mg/kg may be necessary in order to increase rate of successful intubation
What is this paper about
This paper compared adequate paralysis of patients requiring RSI in the field between <1.5mg/kg and >1.5mg/kg Rocuronium being used
The definition of inadequate paralysis was inability to perform laryngoscopy due to movement and inadequate mouth opening, grading of laryngoscope view was not included
Study design
- Retrospective observational study on prospectively collected data
- Single center study
Population
Patients requiring in field intubation in Sydney area via retrieval services
Airway registry database utilized to examine and compare drug dose and relaxation between 2017-2018
Characteristic
- 595 patients included, 211 received < 1.5mg/kg, 384 received >1.5mg/kg
- P value of < 0.05, confidence interval 95%
- Exclusions: documented extravasation of drugs, cold intubation, suxamethonium used, uitilization of LMA or other airway device
Findings
High dose rocuronium lead to 0.5% inadequate relaxation and low dose rocuronium to 2%
Weakness of study design
- Single center observational study
- Intubations performed for different reasons
- Small number of patients
Take home points
Dosing of rocuronium to achieve fast and adequate relaxation is likely higher then often used. A dose of < 1.5mg/kg increases the risk of inadequate intubation.
The safety of high dose Rocuronium (2mg/kg) has not been validated in studies.