Sux onset

[OB1🤙]

the main advantage of sux over rocc in my opinion is no ventilation for sux. just push drug, fasiculate, and go. for roc you have to wait for it to work

I give about 50-60mg roc on induction to most of my hearts. Right as the propofol starts to work so they don't feel the roc burn.

Then I wait for about 20-30 seconds. I almost never mask. Then I intubate. And it's fine.

That roc requires you to mask before intubating is definitely not true, even in doses lower than 4 ED95s.

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[deleted162650]

You don't have to wait. Just mix the roc in the same syringe with the prop and intubate when the patient stops breathing. I almost never ventilate and I almost never use sux. Really the only time I use sux is when I give 10-20mg to break laryngospasm after extubation. I do around 1000cases/year at an L1 trauma center and use sux maybe 3-4 times/year. In Mexico, sux is not even available and their anesthesiologists do just fine.

I just mix the Roc in with the Versed in preop. The key with this technique is to walk fast.

 

[anbuitachi]

I give about 50-60mg roc on induction to most of my hearts. Right as the propofol starts to work so they don't feel the roc burn.

Then I wait for about 20-30 seconds. I almost never mask. Then I intubate. And it's fine.

That roc requires you to mask before intubating is definitely not true, even in doses lower than 4 ED95s.

Oh i agree with that but if I'm giving roc, might as well optimize my conditions. I definitely dont wait 3 minutes for a .6 intubation dose to fully work but i try to wait. Otherwise i can just intubate without paralysis

 

[Psai]

I just mix the Roc in with the Versed in preop. The key with this technique is to walk fast.

If you preoxygenated them, you have more than enough time for the nurse to ask them if they've been to kenya and if your little old lady has a preferred pronoun

 

[sigrhoillusion]

I'm not so sure it ever made sense.

When you first lay eyes on the patient, either the airway gives you pause, or it doesn't.

If it does, the very notion that succinylcholine lends some kind of safety to the induction of that patient and his dodgy airway is flawed. It's not going to wear off before an anoxic brain injury occurs. You shouldn't be inducing those patients pre-tube in the first place.

If it doesn't, and the airway turns out to be the one in a thousand or ten thousand that's a genuinely unexpected nightmare, the sux is still not going to wear off in time to save the patient's brain.

When you're moving down the can't intubate/ventilate algorithm, it doesn't really matter if the patient was paralyzed by succinylcholine or rocuronium. You either ventilate the patient via some mechanism, pronto, or you're both boned. That "wake the patient up" branch only works if you can ventilate the patient.

"If it does, the very notion that succinylcholine lends some kind of safety to the induction of that patient and his dodgy airway is flawed. It's not going to wear off before an anoxic brain injury occurs. You shouldn't be inducing those patients pre-tube in the first place."

THIS! The simplest way to prevent an airway disaster in a patient that you might suspect will be an airway disaster is to NOT induce them... I keep having to explain this to residents and CRNAs. I tell them to re-read the ASA difficult airway algorithm. It seems pretty obvious to me. Expected difficult airway goes down one path. Unexpected difficult airway is in the other path where the patient is already asleep...

I only use SUX for my level 1 traumas that are crashing into the OR. I also DON'T use cricoid. Everyone always reaches for the neck and I tell them to quit it. And then there's the people that ask if they should ventilate... NO!!! And then they say "so a true RSI" WTF is a TRUE RSI?! I'm actually not even sure what "modified" RSI even means.

My RSI is: Facemask on and preox as monitors go on. Push drugs. Watch for fasciculations. Intubate. Only time I do cricoid is if intiial DLs don't work and then I have to ventilate because of desaturations since some studies have shown that cricoid prevents gastric inflation. I may also ask for some pressure to help with my view after I'm already looking.

 

[anbuitachi]

"If it does, the very notion that succinylcholine lends some kind of safety to the induction of that patient and his dodgy airway is flawed. It's not going to wear off before an anoxic brain injury occurs. You shouldn't be inducing those patients pre-tube in the first place."

THIS! The simplest way to prevent an airway disaster in a patient that you might suspect will be an airway disaster is to NOT induce them... I keep having to explain this to residents and CRNAs. I tell them to re-read the ASA difficult airway algorithm. It seems pretty obvious to me. Expected difficult airway goes down one path. Unexpected difficult airway is in the other path where the patient is already asleep...

I only use SUX for my level 1 traumas that are crashing into the OR. I also DON'T use cricoid. Everyone always reaches for the neck and I tell them to quit it. And then there's the people that ask if they should ventilate... NO!!! And then they say "so a true RSI" WTF is a TRUE RSI?! I'm actually not even sure what "modified" RSI even means.

My RSI is: Facemask on and preox as monitors go on. Push drugs. Watch for fasciculations. Intubate. Only time I do cricoid is if intiial DLs don't work and then I have to ventilate because of desaturations since some studies have shown that cricoid prevents gastric inflation. I may also ask for some pressure to help with my view after I'm already looking.

True RSI is the fastest, Modified RSI is not as fast but still fast. It's like rapidly speeding. How rapid are you rapidly speeding?

 

[deleted171991]

People debating roc use and onset should also consider whether their roc is fresh. Best to get it from the fridge every morning.