Order of Drug Administration During Rapid Sequence Intubation with Etomidate May Not Matter

During rapid sequence intubation (RSI), a paralytic and a sedative agent are successively administered to facilitate laryngoscopy with minimal apneic time. The decision about which medication to administer first is rooted in theoretical advantages, such as minimizing time without spontaneous respirations, optimal paralysis, and ensuring adequate sedation.

To study the association between the order of RSI medications and apneic time, researchers conducted a secondary analysis of a randomized, controlled trial comparing a bougie versus endotracheal tube and stylet for first intubation attempt. The analysis included 562 adult patients who were successfully intubated in the emergency department (ED) on the first attempt. Essentially all patients…