(966) Emergency Physician and Nurse Perceptions of Paralytic Duration of Action

Introduction: Non-depolarizing paralytic (NDP) use for rapid sequence intubation (RSI) is increasing among emergency physicians and is associated with higher rates of awareness with paralysis, likely due to longer paralysis duration relative to succinylcholine. It is unclear if emergency physicians and nurses are aware of NDP’s longer duration of action relative to succinylcholine. We examined nurse and physician estimations of duration and hypothesized that nurses would estimate a lower mean duration of action of NDP than physicians.

Methods: Emergency medicine nurses and physicians in a regional healthcare system, including urban teaching and small community hospitals, participated in a structured, anonymous Qualtrics survey. Participants reported basic demographics and self-reported perceptions about succinylcholine and NDP paralysis duration during RSI in minutes. FDA labeling defined reference paralysis duration for succinylcholine (6 minutes) and NDP (rocuronium) (67 minutes).

Results: Of the 87 participants who began the survey, 59 completed at least 88% of the survey and were included (28 nurses and 31 physicians). 98.2% of respondents reported NDP paralytic duration of less than 67 minutes (96.0% of nurses and 100% of physicians). Nurses perceived a significantly lower mean NDP duration (M = 30.9 minutes; SD = 22.1) compared to physicians (M = 43.2 minutes; SD = 14.4) p = .011. In contrast, nurses (M = 15.2, SD = 15.2) trended towards perceiving a longer succinylcholine duration compared to physicians (M = 10.9 minutes; SD = 7.58) p = .08. 23.1% of nurses and 33.3% of physicians reported a mean duration of less than 6 minutes, indicating most overestimated the duration of succinylcholine paralysis.

Conclusions: Nurses and physicians underestimate non-depolarizing paralytic duration, with nurses reporting significantly lower paralytic duration compared to physicians. Nurses and physicians overestimate the duration of succinylcholine similarly. Nurses and physicians may have inaccurate perceptions of paralytic duration, which could impact sedation and analgesic strategies. Future work should compare nurse and physician perceptions to documented paralytic durations to identify methods of improving RSIs.