Analgosedative interventions after rapid sequence intubation with rocuronium in the emergency department

Objectives: The use of etomidate and rocuronium for rapid sequence intubation (RSI) results in a duration of paralysis that exceeds the duration of sedation. The primary objective of this study was to compare the number of analgosedative (AGS) interventions early versus late post-RSI, with this drug combination. The secondary objective was to descriptively assess time to first AGS intervention. Methods: This was a retrospective cohort study conducted in an academic ED in the United States between January 2015 and June 2016. The study was conducted after a pharmacy-led education program. Consecutive adult patients who received the combination of etomidate and rocuronium for RSI were included. The primary outcome measure was the number of AGS interventions post-RSI. An AGS intervention was defined as initiation of an opioid or sedative, or a dose increase of an infusion rate. Interventions were categorized as early (0-30. min post-RSI) or late (60-90. min post-RSI). Results: The sample (n = 108) had a mean age of 58. ±. 19. years, and the majority was male (n = 62, 57%). The mean rocuronium dose was 1.1. ±. 0.3. mg/kg. There was a median of 2 interventions (IQR 1-3) that occurred early versus 0 interventions (IQR 0 to 1) that occurred late post-RSI (p. <. 0.001). The median time to first AGS intervention was 7. min (IQR 3 to 13. min). Conclusions: When rocuronium was used for RSI in the ED there was no delay in provision of post-intubation sedation or analgesia, after a pharmacy-led educational program.