Analgosedative interventions after rapid sequence intubation with rocuronium in the emergency department.

Autor: Kilber E; Department of Pharmacy, Maricopa Integrated Health System, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA; Department of Pharmacy Services, Banner - University Medical Center Tucson, 1501 N Campbell Ave, Tucson, AZ 85724, USA., Jarrell DH; Department of Pharmacy Services, Banner - University Medical Center Tucson, 1501 N Campbell Ave, Tucson, AZ 85724, USA., Sakles JC; Department of Emergency Medicine, College of Medicine, The University of Arizona, PO Box 245057, Tucson, AZ 85724, USA., Edwards CJ; Department of Pharmacy Services, Banner - University Medical Center Tucson, 1501 N Campbell Ave, Tucson, AZ 85724, USA., Patanwala AE; Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, USA. Electronic address: patanwala@pharmacy.arizona.edu.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2018 Jul; Vol. 36 (7), pp. 1129-1133. Date of Electronic Publication: 2017 Nov 14.
DOI: 10.1016/j.ajem.2017.11.022
Abstrakt: Objectives: The use of etomidate and rocuronium for rapid sequence intubation (RSI) results in a duration of paralysis that exceeds the duration of sedation. The primary objective of this study was to compare the number of analgosedative (AGS) interventions early versus late post-RSI, with this drug combination. The secondary objective was to descriptively assess time to first AGS intervention.
Methods: This was a retrospective cohort study conducted in an academic ED in the United States between January 2015 and June 2016. The study was conducted after a pharmacy-led education program. Consecutive adult patients who received the combination of etomidate and rocuronium for RSI were included. The primary outcome measure was the number of AGS interventions post-RSI. An AGS intervention was defined as initiation of an opioid or sedative, or a dose increase of an infusion rate. Interventions were categorized as early (0-30min post-RSI) or late (60-90min post-RSI).
Results: The sample (n=108) had a mean age of 58±19years, and the majority was male (n=62, 57%). The mean rocuronium dose was 1.1±0.3mg/kg. There was a median of 2 interventions (IQR 1-3) that occurred early versus 0 interventions (IQR 0 to 1) that occurred late post-RSI (p<0.001). The median time to first AGS intervention was 7min (IQR 3 to 13min).
Conclusions: When rocuronium was used for RSI in the ED there was no delay in provision of post-intubation sedation or analgesia, after a pharmacy-led educational program.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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