Asking an anesthesiologist or EM doc their choice of paralytic can spark heated debate. What do you prefer?
Succinylcholine:
-depolarizing agent
-30-60 sec onset
-8-15 min duration
-adverse reactions: bradycardia, hyperK, fasciculations, malignant hyperthermia, increased intracranial pressure
-contraindications: herperK, burns or crush injuries, upper motor neuron disorders
Rocuronium:
-non-depolarizing agent
-At 1.2 mg/kg; no difference in time to onset
-45-60 min duration
-contraindications: roc allergy
Proponents of succinylcholine often point to its short duration of action saying that if things go wrong during RSI you only have to bag the patient for 10 min for them to breath spontaneously. While that may be an option in patients undergoing elective surgeries in the OR, this is rarely the case in an ED population. To quote Chris Nickson of Life in the Fast Lane, “If you are performing RSI on a patient and it is feasible to wake them up if things go haywire, then you probably shouldn’t have been doing the RSI in the first place!”
