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document
Rapid-sequence intubation of head trauma patients : prevention of fasciculations with pancuronium versus minidose succinylcholine . INTRODUCTION Fasciculations during rapid-sequence intubation may lead to increased intracranial pressure and emesis with aspiration . Standard rapid-sequence intubation requires a nondepolarizing blocking agent before succinylcholine administration . HYPOTHESIS Prevention of fasciculations during rapid-sequence intubation of head trauma patients can be accomplished as safely and effectively with minidose succinylcholine as with a defasciculating dose of pancuronium . DESIGN A prospective , randomized , double-blind study . SETTING An inner-city county trauma center with 70,000 patient visits per year . PARTICIPANTS Sequential adult head trauma patients requiring rapid-sequence intubation who had no contraindications to succinylcholine or pancuronium . INTERVENTIONS Each head trauma patient requiring rapid-sequence intubation who met the inclusion criteria received standard rapid-sequence intubation maneuvers and lidocaine ( 1 mg/kg ) IV . Patients were randomized to receive either minidose succinylcholine ( 0.1 mg/kg ) or pancuronium ( 0.03 mg/kg ) IV one minute prior to the full paralytic dose of succinylcholine ( 1.5 mg/kg ) IV . Fasciculations were recorded using a graded visual scale . RESULTS Of 46 patients , eight of 19 ( 42 % ) in the pancuronium group and six of 27 ( 22 % ) in the succinylcholine group experienced fasciculations . No statistically significant difference in fasciculations was detected between the two groups using chi 2 analysis . Complete relaxation of the cords was present in all but two patients , one in each group . No patient in either group experienced emesis or significant dysrhythmias . CONCLUSION Pretreatment with minidose succinylcholine causes no greater incidence of fasciculations than pancuronium in rapid-sequence intubation of head trauma patients in an ED setting . Thus succinylcholine may be used as the sole paralytic agent in rapid-sequence intubation of head trauma patients .
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Intervention_Physical
Rapid-sequence intubation
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Intervention_Pharmacological
pancuronium
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Intervention_Pharmacological
minidose succinylcholine
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Intervention_Pharmacological
succinylcholine administration
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Intervention_Pharmacological
succinylcholine
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Intervention_Pharmacological
succinylcholine
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Intervention_Pharmacological
pancuronium
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Intervention_Physical
rapid-sequence intubation maneuvers
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Intervention_Pharmacological
lidocaine
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Intervention_Pharmacological
minidose succinylcholine ( 0.1 mg/kg )
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Intervention_Pharmacological
pancuronium
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Intervention_Pharmacological
full paralytic dose of succinylcholine
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Intervention_Pharmacological
pancuronium
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Intervention_Pharmacological
succinylcholine
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Intervention_Pharmacological
succinylcholine
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Intervention_Pharmacological
pancuronium
16213
Intervention_Pharmacological
succinylcholine
16214
Outcome_Physical
fasciculations
16215
Outcome_Physical
Fasciculations
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Outcome_Physical
emesis
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Outcome_Physical
fasciculations
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Outcome_Physical
Fasciculations
16219
Outcome_Other
graded visual scale
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Outcome_Physical
fasciculations
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Outcome_Physical
fasciculations
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Outcome_Other
Complete relaxation of the cords
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Outcome_Physical
emesis
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Outcome_Physical
significant dysrhythmias
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Outcome_Physical
fasciculations
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Participant_Condition
head trauma
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Participant_Age
adult
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Participant_Sample-size
46