Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review

Tran, D.T.T. et al. (2017) Anaesthesia 72(6) pp. 765–777

This systematic review was performed to determine whether rocuronium creates intubating conditions comparable to those of succinylcholine during rapid sequence intubation of the trachea.

Overall, succinylcholine was superior to rocuronium for achieving excellent intubating conditions (risk ratio (95%CI) 0.86 (0.81 to 0.92), n = 4151) and clinically acceptable intubation conditions (risk ratio (95%CI) 0.97 (0.95–0.99), n = 3992). A high incidence of detection bias amongst the trials coupled with significant heterogeneity means that the quality of evidence was moderate for these conclusions. Succinylcholine was more likely to produce excellent intubating conditions when using thiopental as the induction agent: risk ratio (95%CI) 0.81 (0.73–0.88), n = 2302) with or without the use of opioids (risk ratio (95%CI) 0.85 (0.78–0.93), n = 2292 or 0.85 (0.76–0.95), n = 1428).

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