Dosing of Succinylcholine and Etomidate in Emergency Department Rapid Sequence Intubation

From the NEJM:

A single-center chart review shows that obese patients are at high risk for underdosing.

Current recommendations are that succinylcholine and etomidate be dosed according to total body weight (1–1.5 mg/kg and 0.2–0.4 mg/kg, respectively). Investigators reviewed records from a single emergency department (ED) to determine the frequency of underdosing and overdosing of these medications during rapid sequence intubation.

Of 440 patients in the study, 29% were obese. Succinylcholine was dosed inappropriately in 56% of all patients, etomidate in 24%. Compared with nonobese patients, obese patients were 64 times more likely to be underdosed with succinylcholine, and 178 times more likely to be underdosed with etomidate. Nonobese patients were 63 times more likely to be overdosed with succinylcholine and 167 times more likely to be overdosed with etomidate.

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