Sydney HEMS Sux Contraindications
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While I agree with most of the criticisms of succinylcholine, in my 23 years of practice in busy centers, I have never had a problem with the drug. Since the arrival of Rocuronium, I have been diligent about incorporating its use in my practice. Despite the published literature, my partners and I all agree that Succinylcholine produces good intubating conditions much FASTER than Rocuronium—even with the higher dose 1.6 mg/kg. Not 5 seconds but on the order of 15-30 seconds (our anecdotal experience).
I don’t use succinylchomine during cases of obvious contraindication. I always use Rocuronium if I suspect a difficult airway.
If I need to intubate someone FAST where I may have only one attempt or I know they are going to desaturate quickly, I am convinced Succinylcholine is the superior drug. if the airway is more difficult than anticipated, its easy to add a dose of Rocuronium on top.
I will review the articles you cite regarding the relative desaturation rates between the two drugs.
Anthony – appreciate your thoughts and literature is not a substitute for clinical experience. I haven’t had the issues you’ve had with time of onset and the best literature defends rapid onset with high-dose rocuronium. I think your approach is reasonable and the most important thing you said (in my opinion) is that you always use rocuronium in difficult airways.
While I agree that it’s easy to add a dose of rocuronium, occasionally, I see issues with nursing scrambling to get meds and with pyxis etc, there’s always a delay.