In Nā Papa Hana Paʻi ma ke ao holoʻokoʻa, hoʻopunipuni e hana ana a he hana koʻikoʻi nō ia ma muli o kona mau kūlana a me ke ʻano, ma muli o ke ʻano o ka mea maʻi.

ʻO ka intubations a ED ka mea e hoʻopili ai i ka intubation wikiwiki wikiwiki, me ka koikoiʻi o kahi mea hoʻohui sedative a me kahi lāʻau lapaʻau, akā aia kekahi ala hou e pili ai, ʻo ia ka hoʻohana ʻana o succinylcholine versus rocuronium.

E hōʻoluʻolu i ka holomua mua-pass a me ka hoʻohaʻahaʻa i nā hanana ʻino, nui ka hoʻokō wikiwiki ʻana i nā kūlana intubating kūpono. Hiki i kahi paralysis i ka hopena o ka holomua o ka hoʻohana o ka succinylcholine a me ka rocuronium. ʻOiai ʻo ka mea kākau anesthesia e hōʻike i nā kūlana maikaʻi loa ka holo wikiwiki o ke kaʻina me succinylcholine ma mua o rocuronium, kahi paralytic maikaʻi loa no ka wikiwiki wikiwiki ED ʻike ʻole ʻia.

Nā Papahana

Ua hōʻike mākou i ka ʻikepili i hōʻiliʻili ʻia mai ka National Emergency Airway Registry, kahi waihona multicenter e hōʻiliʻili ana i ka ʻikepili ma nā intubations āpau i hana ʻia ma 22 EDs.

Ua hoʻokomo mākou i nā mea maʻi ma mua o 14 mau makahiki i loaʻa i ka succinylcholine a i ʻole rocuronium i ka makahiki 2016. Hoʻohālikelike mākou i ka holomua intubation o ka mua ma waena o nā mea maʻi e loaʻa ana i ka succinylcholine a me nā mea e loaʻa ana i ka rocuronium.

Ua hoʻohālikelike mākou i ka loaʻa ʻana o nā hanana ʻino (ka hopu ʻana i ka naʻau, ka ʻeha niho, ka ʻeha pololei o ke ea, dysrhythmias, epistaxis, esophageal intubation, hypotension, hypoxia, iatrogenic bleeding, laryngoscope failure, laryngospasm, lip laceration, main-stem bronchus intubation, malignant hyperthermia. ka hewa o ka lāʻau lapaʻau, ka ʻoki ʻana o ka pharyngeal, ka pneumothorax, ka hāʻule ʻole ʻana o ka puʻupuʻu endotracheal, a luaʻi).

Ua hana mākou i kahi subgroup i hoʻopaʻa ʻia e ka maʻi pāpaona pāpaona.

Results

He 2,275 intubations wikiwiki wikiwiki hoʻoikaika ʻia e succinylcholine a me 1,800 e rocuronium. ʻO nā mea maʻi e loaʻa ana i ka succinylcholine he ʻōpio a ʻoi aku paha ke hele a hoʻoweliweli i ke kaʻina me ka laryngoscopy wikiō a me nā mea ʻoi aku ke akamai o ka ʻike.

ʻO ka helu kōkō mua mua a 87.0% me succinylcholine e kū'ē ana i ka 87.5% me ka rocuronium (hoʻohālikelike i ka palena 0.9; 95% hilinaʻi kūmole 0.6 a 1.3). I ka hoʻohālikelike ʻia o kekahi hanana pōʻino i hoʻohālikelike ʻia ma waena o kēia mau mea i paʻi ʻia: 14.7% no ka succinylcholine kūlike ʻoli i ka 14.8% no ka rocuronium (hoʻohālikelike i ka palena 1.1 Ua nānā mākou i nā hopena like i ka wā i hoʻohālikelike ʻia ana lākou e ka maʻi pāpaʻi paona.

Panina

Ma kēia ʻano ʻike nui loa, ʻaʻole mākou i ʻike i kahi hui ma waena o ke koho pākōmū me nā hoʻokūkū wikiwiki mua a i ʻole kūlea peri-intubation.

Authors

• • ʻO Michael D. April, MD, DPhil
  • Allyson'Anana, PhD
  • Daniel J. Pallin, MD, MPH
  • ʻO Robert G. Schauer, DO, MS
    
  • Andrea Fantegrossi, MPH
  • ʻO Jessie Fernandez, BS
  • ʻO Joseph K. Maddry, MD
  • Shane M. Summers, MD
  • Mark A. Antonacci, MD