EBQ:Comparison of Succinylcholine and Rocuronium for RSI - Revision history

Danbot: Added funding information

2026-03-21T22:35:06Z

Added funding information

← Revisión anterior		Revisión del 22:35 21 mar 2026
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	==Funding==		==Funding==


			*None reported

	==References==		==References==

Neil.m.young at 15:43, 29 September 2015

2015-09-29T15:43:37Z

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	*[[Succinylcholine]]		*[[Succinylcholine]]
	*[[Rocuronium]]		*[[Rocuronium]]
			*[[RSI]]

	==External Links==		==External Links==

Neil.m.young at 15:43, 29 September 2015

2015-09-29T15:43:10Z

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	==Interventions==		==Interventions==
	~~Prospective observational study~~ of ~~paralytic use in ED~~		Two cohort RSI groups, one receiving Rocuronium 1.0 mg/kg and the other receiving Succinylcholine at the discretion of the physician

	==Outcomes==		==Outcomes==
	N= 521 patients who received RSI in the ED		N= 521 patients who received RSI in the ED

Catierey: status change

2015-09-28T16:57:48Z

status change

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	\| fulltexturl=		\| fulltexturl=
	\| pdfurl= http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2000.tb00493.x/epdf		\| pdfurl= http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2000.tb00493.x/epdf
	\| status=~~Under Review~~		\| status=Complete
	}}		}}
	==Clinical Question==		==Clinical Question==

Catierey: exclusion criteria

2015-09-21T16:42:41Z

exclusion criteria

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	===Exclusion Criteria===		===Exclusion Criteria===
			*No exclusion criteria noted

	==Interventions==		==Interventions==

Catierey: further discussion

2015-09-21T16:41:56Z

further discussion

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	}}		}}
	==Clinical Question==		==Clinical Question==
	How do succinylcholine and rocuronium compare for use is rapid-sequence intubation in the emergency department?		How do [[succinylcholine]] and [[rocuronium]] compare for use in rapid-sequence intubation in the emergency department?

	==Conclusion==		==Conclusion==
	Both succinylcholine and rocuronium produce fast and reliable paralysis for RSI in the ED.		Both [[succinylcholine]] and [[rocuronium]] produce fast and reliable paralysis for [[RSI]] in the ED.

	==Major Points==		==Major Points==
	{\| class="wikitable"		{\| class="wikitable"
	\|-		\|-
	! Outcome !! Succinylcholine !! Rocuronium !! p value		! Outcome !! [[Succinylcholine]] !! [[Rocuronium]] !! p value
	\|-		\|-
	\| Measured time of onset (± SD) \|\| 39 ± 13 seconds \|\| 44 ± 20 seconds \|\| 0.04		\| Measured time of onset (± SD) \|\| 39 ± 13 seconds \|\| 44 ± 20 seconds \|\| 0.04
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	\| Vocal cord movements 0-10 (± SD) \|\| 9.2 ± 1.6 \|\| 9.0 ± 1.6 \|\| 0.15		\| Vocal cord movements 0-10 (± SD) \|\| 9.2 ± 1.6 \|\| 9.0 ± 1.6 \|\| 0.15
	\|-		\|-
	\| ~~Satisfaction~~ 0-10 (± SD) \|\| 9.4 ± 1.3 \|\| 8.8 ± 2.0 \|\| <0.01		\| Physician satisfaction 0-10 (± SD) \|\| 9.4 ± 1.3 \|\| 8.8 ± 2.0 \|\| <0.01
	\|-		\|-
	\| Related complications \|\| 1: QRS widening in pt with hyperkalemia \|\| 0 \|\| --		\| Related complications \|\| QRS widening in 1 pt with hyperkalemia \|\| 0 related complications \|\| --
	\|-		\|-
	\| Unrelated complications \|\| 7 in 7 patients \|\| 7 in 6 patients \|\| --		\| Unrelated complications \|\| 7 complications in 7 patients \|\| 7 complications in 6 patients \|\| --
	\|-		\|-
	\| Mean ~~Dosage~~ \|\| 1.7 mg/kg \|\| 1.0 mg/kg \|\| --		\| Mean dosage used \|\| 1.7 mg/kg \|\| 1.0 mg/kg \|\| --
	\|}		\|}

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	*Succinylcholine given to 5 patients with pre-existing but unknown hyperkalemia		*Succinylcholine given to 5 patients with pre-existing but unknown hyperkalemia
	**4 pts with serum K between 5.1-6.0 mmol/L		**4 pts with serum K between 5.1-6.0 mmol/L
	**1 pt with serum K for 7.1 mmol/L. Found obtunded, with scalp contusions, without known medical history. Developed widened QRS 30 seconds after succinylcholine administration. Pt found to be in DKA, given medical management for hyperkalemia, and had no clinical adverse affects.		**1 pt with serum K for 7.1 mmol/L.
			***Found obtunded with scalp contusions, without known medical history. Developed widened QRS 30 seconds after succinylcholine administration. Pt found to be in DKA, given medical management for hyperkalemia, and had no clinical adverse affects.
	*No paralytic-related complications were noted in the rocuronium group		*No paralytic-related complications were noted in the rocuronium group
	*No patient desaturated and required assisted ventilations while waiting for paralysis to occur		*No patient desaturated and required assisted ventilations while waiting for paralysis to occur
			*Both groups had complications unrelated to paralytic used
			**These included vomiting, sinus bradycardia during difficult intubation, tube obstruction, chipped teeth, minor oropharyngeal lacerations

	==Study Design==		==Study Design==
	*Prospective cohort study at the UC Davis Medical Center, a level 1 trauma center		*Prospective cohort study at the UC Davis Medical Center, a level 1 trauma center
	*Emergency physicians attended ~~in-service~~ about rocuronium before study, were given information on pharmacologic properties, indications for use, and dose for intubation (1.0 mg/kg used)		*Emergency physicians attended a class about rocuronium before study, where they were given information on its pharmacologic properties, indications for use, and dose for intubation (1.0 mg/kg used)
	*Agreed indications for rocuronium use:		*Agreed indications for rocuronium use per study:
	**Known or suspected hyperkalemia		**Known or suspected hyperkalemia
	**No medical history available		**No medical history available
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	**To avoid a second dose of succinylcholine		**To avoid a second dose of succinylcholine
	*No paralytic agent was mandated, but succinylcholine continued to be first-choice agent.		*No paralytic agent was mandated, but succinylcholine continued to be first-choice agent.
	*Data form completed by intubator immediately after intubation:		*Data form completed by intubator immediately after intubation, which included:
	**Patient's name, age, gender		**Patient's name, age, gender
	**Paralytic used		**Paralytic used
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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
	*Onset of paralysis was only directly measured in 33% patients, with the rest being estimated by the person ~~intubating~~
			===Biases===
			*Without specific inclusion/exclusion criteria, physicians were allowed to hand-pick patients to include in the study, introducing the possibility for selection bias.
			*Patients were not randomized, and physicians were not blinded to medication choice.
			**Satisfaction score and estimated time to paralysis may be biased due to physician's knowledge of the medication.
			**Given the potential adverse effects of succinylcholine, a standard randomized and blinded trial would be nearly impossible given this clinical question.

			===Clinical Significance===
			*Onset of paralysis was only directly measured in 33% patients, with the rest being estimated by the person performing the intubation
	**Significant difference (p=0.04) was calculated only for the measured values, but no statistical significance was calculated for estimated values		**Significant difference (p=0.04) was calculated only for the measured values, but no statistical significance was calculated for estimated values
	**Although statistical significance of onset time was established, clinical significance is unclear as there were no incidences of desaturation in either group		**Although statistical significance of onset time was established, clinical significance is unclear as there were no incidences of desaturation in either group
	*~~Physicians were allowed to hand-pick patients to include in the study without specific inclusion/exclusion criteria, introducing the possibility for selection bias~~.		*Satisfaction score demonstrated a statistical significance of p <0.01
	*~~Patients were not randomized~~, and ~~physicians were not blinded to medication choice~~.		**While this value is clearly statistically significant, clinical significance is unclear. There was only one clinically significant complication, and it occurred in the succinylcholine group.
	**~~Satisfaction score, estimated time~~ to ~~paralysis may be biased~~		**Physicians were not asked to specify why they designated their satisfaction rating for each paralytic agent used

			===Further Discussion===
	*The one complication in this study was seen in a trauma patient with unknown history and no clinical indication for hyperkalemia		*The one complication in this study was seen in a trauma patient with unknown history and no clinical indication for hyperkalemia
	**Physicians must have a high clinical suspicion for hyperkalemia		**Physicians must have a high clinical suspicion for hyperkalemia
			*Patients given rocuronium had more body movements and longer time to paralysis than patients in the succinylcholine group
			**While the mean dose of rocuronium used in this study was 1.0 mg/kg, newer studies suggest that when a dose of 1.2 mg/kg is given, the time to achieving optimum paralysis approaches that of succinylcholine <ref> Herbstritt A. BET 3: Is rocuronium as effective as succinylcholine at facilitating laryngoscopy during rapid sequence intubation. Emerg Med J 2012; 29(3): 256-9. </ref>
			*The clinical question posed in this study was very broad and lacked specificity. Therefore, we cannot draw specific conclusions about which paralytic agent is better, just to say that rocuronium and succinylcholine both provide fast and reliable paralysis for RSI in the ED.

	==See Also==		==See Also==
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	==External Links==		==External Links==
	*[https://vimeo.com/8734733 Rocuronium vs. Succinylcholine Video]		*[https://vimeo.com/8734733 Rocuronium vs. Succinylcholine Video]
			*[http://www.emdocs.net/roc-rocks-sux-sucks-rocuronium-agent-choice-rsi/ emDocs: "Roc Rocks and Sux Sucks!"]

	==Funding==		==Funding==

Catierey: internal links

2015-09-18T21:39:13Z

internal links

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	*Patients were not randomized, and physicians were not blinded to medication choice.		*Patients were not randomized, and physicians were not blinded to medication choice.
	**Satisfaction score, estimated time to paralysis may be biased		**Satisfaction score, estimated time to paralysis may be biased
			*The one complication in this study was seen in a trauma patient with unknown history and no clinical indication for hyperkalemia
			**Physicians must have a high clinical suspicion for hyperkalemia

			==See Also==
			*[[Succinylcholine]]
			*[[Rocuronium]]

	==External Links==		==External Links==

Catierey: major points

2015-09-18T21:32:01Z

major points

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	\|-		\|-
	\| Related complications \|\| 1: QRS widening in pt with hyperkalemia \|\| 0 \|\| --		\| Related complications \|\| 1: QRS widening in pt with hyperkalemia \|\| 0 \|\| --
			\|-
			\| Unrelated complications \|\| 7 in 7 patients \|\| 7 in 6 patients \|\| --
	\|-		\|-
	\| Mean Dosage \|\| 1.7 mg/kg \|\| 1.0 mg/kg \|\| --		\| Mean Dosage \|\| 1.7 mg/kg \|\| 1.0 mg/kg \|\| --
	\|}		\|}

	*No patient desaturated and required assisted ventilations while waiting for paralysis to occur		===Complications===
			*Succinylcholine given to 5 patients with pre-existing but unknown hyperkalemia
			**4 pts with serum K between 5.1-6.0 mmol/L
			**1 pt with serum K for 7.1 mmol/L. Found obtunded, with scalp contusions, without known medical history. Developed widened QRS 30 seconds after succinylcholine administration. Pt found to be in DKA, given medical management for hyperkalemia, and had no clinical adverse affects.
			*No paralytic-related complications were noted in the rocuronium group
			*No patient desaturated and required assisted ventilations while waiting for paralysis to occur

	==Study Design==		==Study Design==
	*Prospective cohort study at the UC Davis Medical Center, a level 1 trauma center		*Prospective cohort study at the UC Davis Medical Center, a level 1 trauma center

Catierey: outcomes

2015-09-18T21:23:47Z

outcomes

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	*138 (26%) received rocuronium		*138 (26%) received rocuronium

	~~Indications for~~
	{\| class="wikitable"		{\| class="wikitable"
	\|-		\|-
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	\|}		\|}

			*34 patients had recorded hyperkalemia (>5 mmol/L) before intubation
			**Rocuronium given to 23 of these patients

	Common sedative agents used:		Common sedative agents used:

Catierey: study design

2015-09-18T20:30:57Z

study design

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	{\| class="wikitable"		{\| class="wikitable"
	\|-		\|-
	! ~~Result~~ !! Succinylcholine !! Rocuronium		! Outcome !! Succinylcholine !! Rocuronium !! p value
	\|-		\|-
	\| Measured time of ~~Onset~~ (± SD) \|\| 39 (± 13) seconds \|\| 44 (± 20) seconds		\| Measured time of onset (± SD) \|\| 39 ± 13 seconds \|\| 44 ± 20 seconds \|\| 0.04
	\|-		\|-
	\| ~~Mean Dosage~~ \|\| 1.~~7 mg/kg~~ \|\| 1.0 ~~mg/kg~~		\| Frequency of body movements 0-10 (± SD) \|\| 9.5 ± 1.1 \|\| 9.1 ± 1.5 \|\| 0.01
	\|-		\|-
	\| Satisfaction 0-10 (± SD) \|\| 9.4 (± 1.3) \|\| 8.8 (± 2.0)		\| Vocal cord movements 0-10 (± SD) \|\| 9.2 ± 1.6 \|\| 9.0 ± 1.6 \|\| 0.15
			\|-
			\| Satisfaction 0-10 (± SD) \|\| 9.4 ± 1.3 \|\| 8.8 ± 2.0 \|\| <0.01
			\|-
			\| Related complications \|\| 1: QRS widening in pt with hyperkalemia \|\| 0 \|\| --
			\|-
			\| Mean Dosage \|\| 1.7 mg/kg \|\| 1.0 mg/kg \|\| --
	\|}		\|}

			*No patient desaturated and required assisted ventilations while waiting for paralysis to occur
	==Study Design==		==Study Design==
	*Data form completed by intubator immediately after intubation ~~with following info~~		*Prospective cohort study at the UC Davis Medical Center, a level 1 trauma center
	**Patient's name, age, gender~~, paralytic~~ used~~, reason~~ for use~~, time~~ from administration to paralysis~~, serum~~ K at time of intubation~~, need~~ for BVM ~~ventilations, pulse~~ ox readings during intubation~~, any complications~~		*Emergency physicians attended in-service about rocuronium before study, were given information on pharmacologic properties, indications for use, and dose for intubation (1.0 mg/kg used)
			*Agreed indications for rocuronium use:
			**Known or suspected hyperkalemia
			**No medical history available
			**Signs of increased intracranial pressure
			**Chronic neuromuscular disease
			**Crush injury
			**Non-acute burns
			**Globe injury
			**To avoid a second dose of succinylcholine
			*No paralytic agent was mandated, but succinylcholine continued to be first-choice agent.
			*Data form completed by intubator immediately after intubation:
			**Patient's name, age, gender
			**Paralytic used
			**Reason for use
			**Time from administration to paralysis
			**Serum K at time of intubation
			**Need for BVM ventilation
			**Pulse ox readings during intubation
			**Complications

	==Population==		==Population==
	===Patient Demographics===		===Patient Demographics===