Introduction: Rapid sequence intubation (RSI) is a procedure often done in the emergency department (ED) to secure the airway in patients in respiratory failure. It is a process done by administering sedative and neuromuscular blocking agents, in rapid succession to allow for endotracheal intubation. Succinylcholine is a common paralytic agent used in RSI due to its quick onset and short duration. Common dosing for succinylcholine ranges from 1-1.5 mg/kg based on total body weight (TBW) with a maximum of 150mg, but larger doses have been evaluated in specific comorbidities. Many studies suggest that optimal dosing is not achieved in obesity due to dosing maximums and may lead to suboptimal intubation conditions. The objective of this study was to evaluate appropriate succinylcholine dosing for RSI within different weight groups. Methods: Adult patients who were intubated by an ED provider with succinylcholine in the ED from January 2023 to December 2024 were evaluated for inclusion within this study. Subjects were divided by body mass index (BMI) scores into >30kg/m2 or 30kg/m2 group. There was no difference found between BMI groups with regard to appropriate dosing of succinylcholine (p = 0.560). Upon review of patients who received inappropriate doses, patients with a BMI 30kg/m2 were more likely to be underdosed (p30kg/m2 or BMI < 30kg/m2. Adverse effects related to succinylcholine were similar between BMI groups.
Benson et al. (Sun,) studied this question.
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