Dilemma In Rapid Sequence Intubation: Succinylcholine Vs. Rocuronium

Succinylcholine is the single ultra-short acting depolarizing neuromuscular blocking agent (NMBA) used in the rapid sequence intubation protocol with its rapid onset of effect, complete reliability, short duration of action. Rocuronium is diverse from other non-depolarizing NMBA being the first one with a short onset time and devoid of untoward effects. Despite its widespread use, succinylcholine has several potential hazards including an increase in potassium levels, bradycardia for children and prolonged apnea for those with pseudocholinesterase deficiency. Rocuronium is indicated in subjects with disease states such as known or suspected hyperkalemia, crush injury, non-acute burns, increased intracranial or intraocular pressure and neuromuscular disease. Although succinylcholine has many side effects, it remains to be the first-choice NMBA for the majority of attempts for rapid sequence intubation. Rocuronium may be a suitable alternative to succinylcholine with its short onset time. The objective of this article is to update data from studies comparing the use of succinylcholine and rocuronium in rapid sequence intubation protocol in adults.