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Podcast Review #3: The Elective Rotation: A Critical Care Pharmacy Podcast – Sux vs. Rox

I’ve been trying to make an effort to make my self-education more streamlined and automatic, so I’ve been looking for podcasts and other forms of media that are easily consumed. In my search, I stumbled across this podcast hosted by a critical care pharmacist. This was the first episode I decided to listen to while running and…I really enjoyed it.

I’m not a critical care pharmacist but I’m definitely interested in learning and becoming better at my job of helping patients. This particular podcast dived into the long-running debate of whether rocuronium (Roc) or succinylcholine (Sux) is the better paralytic for rapid sequence intubation (RSI).

Some important points that this podcast made me more cognizant of:

  • Both Sux and Roc have essentially the same onset of action if dosed correctly. Sux is usually though of as the faster onset drug, but Rocuronium will work w/in the same 45 second window if you dose it at 1.2 mg/kg.
  • Rocuronium has a much longer paralysis time period ~ 90 mins vs. 10 minutes with Sux – which is usually a reason Sux is heralded as a safer option.
  • Both allow for equal success in first chance intubation, although b/c of rocuronium’s longer paralysis time period – doing neurological function tests may be out of the question for a longer period of time.
  • Relative vs. absolute contraindications for succinylcholine: With high potassium, crush wounds, or other myopathies with CPK rocuronium is often thought of as the safer more risk averse choice..however succinylcholine’s risk with higher potassium is often overstated and in patients with just hyperkalemia it may not be a terrible choice.

I learned a lot and look forward to further podcast from this pharmacist!

-OFO

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