Effect of patient weight on first pass success and neuromuscular blocking agent dosing for rapid sequence intubation in the emergency department

Patanwala, Asad E.; Sakles, John C.

doi:10.1136/emermed-2017-206762

Cited by 8 publications

(4 citation statements)

References 34 publications

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“…Therefore, cohorts reported were a small part of the entire population of hospitalized patients; no estimate of the overall succinylcholine administration rate per patient per unit of time could be made (Supplemental Digital Content 2, http://links.lww.com/ALN/ B799). [27][28][29][30][31][32][33][34] 1b. Procedural Suites (Radiology, Electroconvulsive Therapy) Multicenter Perioperative Outcomes Group Database Search.…”

Section: Resultsmentioning

confidence: 99%

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment

Larach¹,

Klumpner

Brandom

et al. 2019

Anesthesiology

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EDITOR’S PERSPECTIVE What We Already Know about This Topic Dantrolene effectively treats malignant hyperthermia, but there are discrepant recommendations for dantrolene availability in facilities that stock succinylcholine for airway rescue but do not use volatile anesthetics. What This Article Tells Us That Is New The authors performed an analysis of data from three databases and a systematic literature review. Providers frequently use succinylcholine, including during difficult mask ventilation. Succinylcholine given without volatile anesthetics triggered 24 malignant hyperthermia events, 13 of which were treated with dantrolene. Fourteen patients experienced substantial complications, and one died. Delayed dantrolene treatment worsened patient outcomes. Background Although dantrolene effectively treats malignant hyperthermia (MH), discrepant recommendations exist concerning dantrolene availability. Whereas Malignant Hyperthermia Association of the United States guidelines state dantrolene must be available within 10 min of the decision to treat MH wherever volatile anesthetics or succinylcholine are administered, a Society for Ambulatory Anesthesia protocol permits Class B ambulatory facilities to stock succinylcholine for airway rescue without dantrolene. The authors investigated (1) succinylcholine use rates, including for airway rescue, in anesthetizing/sedating locations; (2) whether succinylcholine without volatile anesthetics triggers MH warranting dantrolene; and (3) the relationship between dantrolene administration and MH morbidity/mortality. Methods The authors performed focused analyses of the Multicenter Perioperative Outcomes Group (2005 through 2016), North American MH Registry (2013 through 2016), and Anesthesia Closed Claims Project (1970 through 2014) databases, as well as a systematic literature review (1987 through 2017). The authors used difficult mask ventilation (grades III and IV) as a surrogate for airway rescue. MH experts judged dantrolene treatment. For MH morbidity/mortality analyses, the authors included U.S. and Canadian cases that were fulminant or scored 20 or higher on the clinical grading scale and in which volatile anesthetics or succinylcholine were given. Results Among 6,368,356 queried outcomes cases, 246,904 (3.9%) received succinylcholine without volatile agents. Succinylcholine was used in 46% (n = 710) of grade IV mask ventilation cases (median dose, 100 mg, 1.2 mg/kg). Succinylcholine without volatile anesthetics triggered 24 MH cases, 13 requiring dantrolene. Among 310 anesthetic-triggered MH cases, morbidity was 20 to 37%. Treatment delay increased complications every 10 min, reaching 100% with a 50-min delay. Overall mortality was 1 to 10%; 15 U.S. patients died, including 4 after anesthetics in freestanding facilities. Conclusions Providers use succinylcholine commonly, including during difficult mask ventilation. Succinylcholine administered without volatile anesthetics may trigger MH events requiring dantrolene. Delayed dantrolene treatment increases the likelihood of MH complications. The data reported herein support stocking dantrolene wherever succinylcholine or volatile anesthetics may be used.

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Section: Resultsmentioning

confidence: 99%

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment

Larach¹,

Klumpner

Brandom

et al. 2019

Anesthesiology

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“…FPS was a secondary outcome in this trial, which had similar results: FPS rate of 82% in the rocuronium group versus 84% in the succinylcholine group. A pooled analysis of the four observational studies did not show a significant difference with regard to FPS (difference: −2%; 95% CI, −6% to 2%) (88–91).…”

Section: Resultsmentioning

confidence: 89%

“…However, there are concerns regarding the risk of awareness when rocuronium is used because of its long duration of action (30–60 min), which could potentially mask suboptimal post-RSI analgosedation. Thirty-one studies were included for evaluation to address this question (1, 59, 85–113). One observational single-center study evaluated the effect of the choice of NMBA on mortality in 233 patients undergoing RSI (85).…”

Section: Resultsmentioning

confidence: 99%

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Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient

Acquisto,

Mosier,

Bittner

et al. 2023

Critical Care Medicine

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RATIONALE: Controversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI). OBJECTIVES: To develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI. DESIGN: A guideline panel of 20 Society of Critical Care Medicine members with experience with RSI and emergency airway management met virtually at least monthly from the panel’s inception in 2018 through 2020 and face-to-face at the 2020 Critical Care Congress. The guideline panel included pharmacists, physicians, a nurse practitioner, and a respiratory therapist with experience in emergency medicine, critical care medicine, anesthesiology, and prehospital medicine; consultation with a methodologist and librarian was available. A formal conflict of interest policy was followed and enforced throughout the guidelines-development process. METHODS: Panelists created Population, Intervention, Comparison, and Outcome (PICO) questions and voted to select the most clinically relevant questions for inclusion in the guideline. Each question was assigned to a pair of panelists, who refined the PICO wording and reviewed the best available evidence using predetermined search terms. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used throughout and recommendations of “strong” or “conditional” were made for each PICO question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and best practice statements, when the benefits of the intervention outweighed the risks, but direct evidence to support the intervention did not exist. RESULTS: From the original 35 proposed PICO questions, 10 were selected. The RSI guideline panel issued one recommendation (strong, low-quality evidence), seven suggestions (all conditional recommendations with moderate-, low-, or very low-quality evidence), and two best practice statements. The panel made two suggestions for a single PICO question and did not make any suggestions for one PICO question due to lack of evidence. CONCLUSIONS: Using GRADE principles, the interdisciplinary panel found substantial agreement with respect to the evidence supporting recommendations for RSI. The panel also identified literature gaps that might be addressed by future research.

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Neue Aspekte der „rapid sequence induction“ einschließlich Behandlung der pulmonalen Aspiration

2021

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Effect of patient weight on first pass success and neuromuscular blocking agent dosing for rapid sequence intubation in the emergency department

Abstract: Very heavy patients (>120 kg) undergoing RSI in the ED had a reduced FPS, and succinylcholine was more commonly underdosed than rocuronium in the heavier weight group.

Cited by 8 publications

References 34 publications

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment

Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient

Neue Aspekte der „rapid sequence induction“ einschließlich Behandlung der pulmonalen Aspiration

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