(1013) Time to Analgosedation Following Rapid Sequence Intubation

Introduction: Patients often receive neuromuscular blocking agents (NMBAs) during rapid sequence intubation (RSI) as these agents will facilitate intubation by causing relaxation of skeletal muscle. The most common NMBAs used during RSI are succinylcholine and rocuronium. These agents both have a rapid onset (less than 1 minute) but have varying duration of activity; succinylcholine has a duration of 5-15 minutes whereas rocuronium has a duration of 45-70 minutes.

Methods: This was a single-center, retrospective review of electronic health record (EHR) data of patients who underwent RSI for mechanical ventilation at UAMS Medical Center during the time periods of January 1, 2019 to June 30, 2019 AND January 1, 2022 to June 30, 2022. Subjects were included if: > 18 years old and underwent intubation on an inpatient unit during the specified time periods. Patients were excluded if they were intubated prior to arrival or intubated in the ED or OR. The primary outcome was to evaluate time to analgosedation initiation post-paralytic administration for RSI. Secondary outcomes included analgesia and sedation received with paralytic during RSI.

Results: 359 patients were included in the review. The average age was 58 years and 58% were male. A total of 168 patients received rocuronium while 194 patients received succinylcholine; 3 patients received both agents. The average time to analgesia was similar in each paralytic group, ~40 minutes; average time to sedation was 33 minutes in the succinylcholine group and 57 minutes in the rocuronium group. 43 patients did not have documented analgosedation within 2 hours post-paralytic. In comparing analgesia and sedation used during RSI, propofol was used in 16% of rocuronium patients and in 19.5% of succinylcholine patients; fentanyl was used in 18% of rocuronium patients and 14% of succinylcholine patients; midazolam was used in 20% of rocuronium patients and 14% of succinylcholine patients.

Conclusions: While time to analgesia initiation was similar, patients who received rocuronium had a longer time to sedation initiation. However, patients who received rocuronium were more likely to have received fentanyl and midazolam during RSI.