(1472) Delays in Sedation Between Short- and Long-Acting Paralytics

Introduction: Patients undergo rapid sequence intubation (RSI) in many settings in the hospital. RSI involves giving a rapidly acting sedative plus a neuromuscular blocking agent to facilitate in the placement of an endotracheal tube (ETT). Rocuronium and succinylcholine are two commonly used neuromuscular blocking agents used in RSI that have different lengths of durations. This study was to evaluate delays in sedation, which can result patients being paralyzed without sedation. Rocuronium has a longer duration of action compared to succinylcholine, however, there is a gap in the literature describing the onset of sedation when the two agents are compared.

Methods: This was a single-center retrospective study performed at a quaternary level one trauma center. We included patients who presented to the emergency department or intensive care unit who required the placement of an ETT. Our primary outcome was time to sedation after intubation. We performed a logistic regression to assess relationships between paralytic agents and delayed sedation.

Results: We analyzed a total of 612 medical records; 402 were included in the final sample. A total of 242 (60.04%) patients received rocuronium and 159 (39.45%) received succinylcholine. Mean time to any sedative or analgesia was longer for those who received rocuronium (256 min vs 153 min, difference 103 min. The unadjusted odds of delayed sedation for those who received succinylcholine was significantly lower than those who received rocuronium (OR of 0.29 [95% CI: [0.19, 0.44]).

Conclusions: Patients who received rocuronium were more likely to have delayed sedation when compared with those who received succinylcholine. This may be because patients are paralyzed for a longer duration with rocuronium, which is concerning for awareness with paralysis. Future studies can identify ways to reduce time to sedation and practices to ensure patients are adequately sedated, especially when longer acting paralytic is being used.