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A CRNA's View Of Succinylcholine vs. Rocuronium

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JCole View Drop Down
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Joined: 03 Oct 2007
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    Posted: 30 Aug 2009 at 4:10pm
A CRNA's View Of Succinylcholine vs. Rocuronium

When you consider the #1 cause of serious anesthesia problems is losing control of the airway, assuming you are going to be able to intubate someone and then not being able to do so causes much chest tightening. Unless there is a really good reason based upon the patient history or condition, I routinely use succinylcholine (succ) to intubate. Then I wait for it to wear off before I give any other muscle relaxants. In fact, out of two 10cc bottles of succ, I load three syringes, each with 7cc of succ. That way if I can not get the patient intubated, I will not be tempted to "give a little more" and try again. If I can not get the patient intubated by the time the succ is wearing off, I bail out, wake the patient up and then do an awake intubation.

The ONE TIME I saw an otherwise healthy patient get an emergency trach was when a student used rocuronium (Roc) to intubate and he could not get it. So the CRNA tried and he could not get it. Then the MDA tried and he could not get it. Then the patient got swelling from all the attempts, was not coming back form the Roc and got trached. Of course, I pointed out they would not have gotten into that mess if they had used succinylcholine (succ) and bailed out.

I think having a "bail out" plan is just as important as having a "plan B."

And as far as all the "dangers" of succ that people harp on. I would rather explain a drug problem in court than explain why I used a medium to long muscle relaxant and lost control of the airway. Juries are very understanding of drug reactions but they are not so forgiving of you "losing control" of something that was OK before you started.

In 33 years of practice, I only had one occasion of acute cheek tightness over the airway. And that was, believe it or not, one of the few times I used rocuronium (Roc) to intubate.


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