Alternatives to succinylcholine?

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Exactly, that's why in common RSI l would always prefer Roc over Sux,
leaving sux for some specific situations.

Ante

2010/8/23 Ian Seppelt <seppelt at med.usyd.edu.au>

> RSI stands for Rapid Sequence INDUCTION (of anaesthesia), as originally
> developed for obstetrics. Those who have subverted it into 'Rapid Sequence
> Intubation' have missed the point - shoving a bit of plastic into a hole is
> not the primary purpose of the exercise - management of the patient,
> including appropriate induction and airway management is the object.
>
> Ian
>
>
> On 24/08/2010, at 1:54 AM, "Bjorn, Pret" <pbjorn at emh.org> wrote:
>
>  A teachable moment for me: I was not aware that RSI was ever specific to
>> thiopental and suxamethonium, or exclusive of anything else.
>>
>> Is there a reference?
>>
>> Pret
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org [mailto:
>> trauma-list-bounces at trauma.org] On Behalf Of Ross Hofmeyr
>> Sent: Monday, August 23, 2010 11:33 AM
>> To: Trauma-List [TRAUMA.ORG]
>> Subject: Re: Alternatives to succinylcholine?
>>
>> Pendantic, but forgive me:
>>
>> RSI (Rapid Sequence Induction) is a term which, when used in it's pure
>> form,
>> _specifically_ refers to the use of a predetermined dose of sodium
>> thiopental followed immediately by a predetermined dose of suxamethonium.
>> Anything else is a 'Modified' RSI, although most people have come to refer
>> to "RSI" as any rapid induction agent (thio, propofol, ketamine or
>> etomidate) with sux, and MRSI as any of those with rocuronium.
>>
>> The accepted MRSI dose of rocuronium is 1.2mg/kg, although once again many
>> just use 1mg/kg for simplicity.
>>
>> Sux has significant and well-known problems, and while onset is slightly
>> faster than roc it wears of much more rapidly (still, it's a fool's
>> paradise
>> to presume that if you fail intubation the patient will be breathing
>> before
>> they desaturate from sux).  An MRSI dose of roc will leave your patient
>> paralysed for the better part of an hour...
>>
>> R.
>>
>> On 23 August 2010 17:20, Ante Ćorić <ante.coric85 at gmail.com> wrote:
>>
>>  There is: Roc 1mg/kg iv. has same speed of action as sux. But maybe sux
>>> shouldn't be so widely spread in usage, as routine drug to be pushed in
>>> RSI,
>>> especially by non anaesthetists (MDs not mid levels that is). Most of RSI
>>> can be done w/o relaxans at all. Sux is should always be present if you
>>> admit kids.
>>>
>>> just my 2 cents
>>>
>>> Ante
>>>
>>> 2010/8/23 T. Al West <talwest at mac.com>
>>>
>>>  Hello fellow trauma-listers:
>>>>
>>>> As you may know, there is a national shortage of succinylcholine. I
>>>> don't
>>>> know how many hospitals have gotten caught with their pants down by not
>>>> stockpiling, but I know mine certainly has--less than 20 doses remain in
>>>>
>>> the
>>>
>>>> hospital. I agree with our anesthesiologists that we really can't
>>>>
>>> function
>>>
>>>> effectively as a trauma center without this medication.
>>>>
>>>> Is this position valid? Is there any reasonable alternative to "sux" for
>>>> rapid sequence intubation, from a safety/efficacy standpoint in a trauma
>>>> situation?
>>>>
>>>> Thanks in advance for your comments.
>>>>
>>>> T. Al West, MD, FACS
>>>> Medical Director, Trauma Services
>>>> The Medical Center of Plano
>>>> --
>>>> trauma-list : TRAUMA.ORG
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>>>>
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>>>
>>
>>
>> --
>> Dr Ross Hofmeyr
>> wildmedic at gmail.com
>> ross at wildmedix.com
>> www.wildmedix.com
>> Tel: +2784 54 99259
>> Skype:  wildmedic
>> “Semper Paratus”
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>>
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>

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