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

Emily Kilber, Daniel H. Jarrell, John C. Sakles, Christopher J. Edwards, Asad E. Patanwala

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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 (0–30 min post-RSI) or late (60–90 min post-RSI). Results: The sample (n = 108) had a mean age of 58 ± 19 years, and the majority was male (n = 62, 57%). The mean rocuronium dose was 1.1 ± 0.3 mg/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 7 min (IQR 3 to 13 min). 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.

Original languageEnglish (US)
Pages (from-to)1129-1133
Number of pages5
JournalAmerican Journal of Emergency Medicine
Issue number7
StatePublished - Jul 2018


  • Anesthesia and analgesia
  • Awareness
  • Emergency medical services
  • Hypnotics and sedatives
  • Intubation
  • Neuromuscular blocking agents

ASJC Scopus subject areas

  • Emergency Medicine


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