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LETTER TO THE EDITOR

Rocuronium in Emergent Intubation

Intensive Care Unit; Hospital Universitario Puerta de Hierro; Madrid, Spain; cchamorro.hpth{at}salud.madrid.org

To the Editor:

The interesting study published by Sluga et al. (1) could be misinterpreted concerning the use of succinylcholine and rocuronium for emergency tracheal intubation. For surgical emergencies (unscheduled emergency operations), there is typically time to obtain serum electrolytes, a medical history, and written informed consent, as happened in Sluga et al.’s study. However, during emergency tracheal intubations in other settings (e.g., shock, trauma) there is no time to assess renal function status, potassium levels, previous neurologic disorders, or whether the patient has had a long period of immobilization. We reviewed the medical records of all patients who required emergency tracheal intubation in our intensive care unit over the course of 1 yr. Thirty-five percent had at least one condition that potentially contraindicated the use of succinylcholine (2). In several cases, succinylcholine may have precipitated the subsequent cardiac arrest. As Sluga et al. observe, rocuronium results in less optimal, but good, intubating conditions compared with succinylcholine. Other authors have reached the same conclusion (3,4). For these reasons we have replaced succinylcholine with rocuronium for emergency tracheal intubation outside of the operating room. In our view, succinylcholine is an obsolete (5) and potentially dangerous drug for intubating patients in settings where one cannot eliminate well-established contraindications to its use.

Footnotes

Dr. Marsch does not wish to respond.

REFERENCES

1. Sluga M, Ummenhofer W, Studer W, et al. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases. Anesth Analg 2005;101:1356–61.[Abstract/Free Full Text]
2. Pardo C, Chamorro C, Romera MA, et al. Succinil-colina ¿bloqueante neuromuscular de elección para la intubación de pacientes críticos? Med Intensiva 2001;25(Suppl 1):89.
3. Tryba M, Zhorn A, Thole H, Zenz M. Rapid-sequence oro-tracheal intubation with rocuronium: a randomized double-blind comparison with suxamethonium, preliminary communication. Eur J Anaesthesiol 1994;11(suppl 9):44–8.
4. Chamorro C, Martinez-Melgar JL, Romera MA, et al. Uso de rocuronio en la secuencia rápida de inducción-intubación de los pacientes críticos. Med Intensiva 2000;24:253–6.
5. Booij LH. Is succinylcholine appropriate or obsolete in the intensive care unit? Crit Care 2001;5:245–6.[Web of Science][Medline]

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