NextGen Learning To Elevate Your Airway Practice
Paralytic Agents
Overview of Paralytic Agents in Rapid Sequence Intubation (RSI)
Paralytic (neuromuscular blocking) agents are essential in Rapid Sequence Intubation (RSI). They facilitate optimal conditions for endotracheal intubation by eliminating muscle tone, suppressing the gag reflex, and preventing patient movement. They are administered with the induction agent to ensure rapid and smooth intubation. We cover the most commonly used agents below.
Rapid Sequence Induction
An overview & role of paralytics
Before we discuss specific paralytics in detail, let’s watch this brief review of RSI. At its core, RSI rapidly and sequentially sedates and paralyzes the patient to improve intubating conditions and minimize the risk of aspiration.
Adopted from: ICU Advantage channel, YouTube, 2022.
Rocuronium
Rocuronium is a newer neuromuscular blocking agent that differs from succinylcholine in two critical ways. It is non-depolarizing and does not cause fasciculations, hyperkalemia, or significant adverse reactions. Unsurprisingly, it has become the preferred agent for emergency providers, where medical history may not always be available. However, it causes paralysis that lasts almost 10 times longer than succinylcholine, putting you and your patient at risk for awake paralysis.
An even more important reminder!
Paying attention to the duration of action of RSI medications could not be more critical than when Rocuronium is used for paralysis. As you can see below, it lasts far longer than the medications most commonly used for induction.
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