Rocuronium and Succinylcholine Are Equally Effective at Doses ≥1 mg/kg

This author conducted a structured literature review of studies that compared succinylcholine and rocuronium at doses ≥1 mg/kg to determine whether the two agents are similarly effective in providing optimal conditions for emergency intubation. Of seven papers that were considered relevant, three were conducted in the emergency department (ED) setting, and one was a Cochrane review.

A prospective cohort analysis of 578 ED patients showed that succinylcholine provided paralysis 5 seconds earlier than rocuronium (the difference was not considered clinically relevant), and the two agents produced similar intubating conditions. A retrospective study of 327 ED patients showed no significant difference in first-attempt intubation success between the two agents (JW Emerg Med Feb 18 2011). The Cochrane review found no difference between the two agents in producing excellent or acceptable intubating conditions. The remaining four studies, which were conducted in the surgery setting, had similar findings.