Suxamethonium or rocuronium for rapid sequence induction of anaesthesia? A reply
Notice bibliographique
Résumé
I thank Dr. Dinsmore for his comments on our systematic review comparing succinylcholine and rocuronium for rapid sequence intubation 1, which is the fourth update of the original paper reported in 2002 2. The study comparison of succinylcholine 1.0 mg.kg−1 vs. a minimum of 0.6 mg.kg−1 rocuronium was a relevant dosing question, as the efficacy of 1.0 mg.kg−1 rocuronium was not established practice at that time. The subgroup analyses for this study with the specific dosing comparisons were made a priori, as well as the primary outcome definition of ‘excellent intubating conditions’ in 2002. ‘Acceptable intubating conditions’ was a secondary outcome, encompassing both ‘excellent’ and ‘good’ intubating conditions. The Cochrane collaboration encourages the updating systematic reviews to accommodate data from new trials, especially if the conclusions of the systematic review may change. With this update, we have maintained our consistent methodology in reporting the primary outcome: excellent intubating conditions with the same subgroup analyses of rocuronium dosing. In the discussion, we concluded that ‘succinylcholine created significantly more excellent intubation conditions than rocuronium at doses of 0.6–0.7 mg.kg−1’, but in the next sentence we also stated that ‘there was no statistically significant difference for the 0.9–1.0 mg.kg−1 or 1.2 mg.kg−1 groups, reaffirming the current practice of using 1 mg.kg−1 of rocuronium for rapid sequence intubation when succinylcholine is not clinically indicated’. This statement allowed us to report the answer to our original research question from 2002 comparing 1.0 mg.kg−1 of succinylcholine vs. 0.6 mg.kg−1 of rocuronium, but also to highlight the current practice of using a higher dose of rocuronium for rapid intubation. With regard to the resultant prolonged neuromuscular block with higher doses of rocuronium, this is the first update to mention the new reversal agent sugammadex. Its availability certainly makes the prolonged effects of rocuronium less concerning for those who have immediate access to it. Sugammadex is well suited for the treatment of unwanted residual muscle paralysis, but its use in difficult airway management or emergencies has not been studied. The availability of sugammadex is not consistent within the affluent nations and its cost is prohibitive for many countries around the world. Thus, the authors felt it was still prudent to continue to warn readers that 1.0 mg.kg−1 of rocuronium was equally effective as 1.0 mg.kg−1 of succinylcholine, at the cost of a much longer paralysis period. Certainly the clinical question addressed in this systematic review has been settled in current clinical practice, with the administration of 1.0 mg.kg−1 rocuronium to patients for rapid sequence induction when succinylcholine is not appropriate. Conversely, this review should also remind readers that, when selected appropriately, succinylcholine is still an excellent choice to produce the most optimal intubation conditions, especially in emergencies and when the airway is challenging to secure.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».