The use of neuromuscular blocking agents in the emergency department to facilitate tracheal intubation in the trauma patient: help or hindrance
Information Services, Academic Computing Services; Department of Anesthesiology; Department of Emergency Medicine
Adult; *Emergency Treatment; *Facial Injuries; Female; Humans; *Intubation, Intratracheal; Male; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Registries; Respiratory System; Retrospective Studies; Succinylcholine; Vecuronium Bromide
Anesthesiology | Emergency Medicine | Life Sciences | Medicine and Health Sciences
PURPOSE: The purpose of this study is to examine the relationship between the occurrence of a difficult intubation and (1) the use of neuromuscular blocking agents (NMB) and (2) the presence of airway injuries. It is a retrospective analysis of data from a trauma registry.
MATERIALS AND METHODS: Registry records of patients (n = 160) who required emergent endotracheal intubation or establishment of a surgical airway over a 3.5-year period in the emergency department were reviewed. Risk factors for difficult intubations were identified and analyzed using multivariate logistic regression analysis.
RESULTS: NMB were used in 75% of patients requiring intubation. Fifteen percent of the intubations were considered difficult. No association was found between the presence of airway injuries and difficult intubations; however, the use of succinylcholine was associated with a lower risk of difficult intubations compared with intubations where a nondepolarizing NMB was used.
CONCLUSIONS: The use of succinylcholine may result in fewer difficult intubations in the trauma patient than when a nondepolarizing NMB is used. The presence of airway injuries did not appear to predispose to difficult intubations.
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Citation: J Crit Care. 1998 Mar;13(1):1-6.