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Pediatric RSI

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

What's your paralytic for standard pediatric RSI?

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pemsou5_wp • April 16, 2021

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  1. Kelly April 16, 2021 - 5:45 pm Reply

    The controversy of succinylcholine vs rocuronium for ED RSI has been ongoing for years. Succinylcholine has been shown in some studies to produce better intubating conditions more quickly. It also is shorter acting, so that if intubation is unsuccessful, the patient is not paralyzed for as long. Proponents of rocuronium, however, point to evidence that a higher dose of 1.2 mg/kg of rocuronium produces intubating conditions close to as quickly as succinylcholine. Rocuronium does not carry the long list of contraindications that succinylcholine does: e.g. hyperkalemia, recent burn/trauma 24-72 hours ago, muscle myopathies, rhabdomyolysis, history of malignant hyperthermia. For children, the possibility of an undiagnosed muscle myopathy such as Duchenne’s is a particular concern. Also, if the reversal agent sugammadex is available, rocuronium (and vecuronium’s) paralytic effects may be reversed if intubation is unsuccessful. Clinicians commonly only attempt intubation without paralytics in neonates, although certain specific clinical situations could warrant such attempts.

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