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Post by Chuck Eder on Aug 30, 2018 22:16:32 GMT -5
Like others, I have taken over cases where both relaxants have been used. I prefer to stick with one throughout the whole case. By adding another agent (muscle relaxant), you could be increasing the chance for an allergic reaction.
The faster onset of Roc make it a good choice for RSI if succinlycholine is contraindicated. Roc is also a med that does not need reconstituted, which may play a role in a provider's choice.
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nanci
Junior Member
Posts: 57
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Post by nanci on Aug 31, 2018 13:26:22 GMT -5
1)I'm not sure if it is "bad practice" to switch up muscle relaxants during a case. As optimal as it would seem to continue utilizing the same muscle relaxant, longer cases and less of a drug in a pyxis, and delays in having someone bring medications to the room may lead to changing up and using a different muscle relaxant. Quick inductions with one medication and switching to a more reliably timed medication for subsequent dosing has also happened. There is such variation in some clinical days that I can certainly see different scenarios on why one would switch medications. I'd like to think that all would like to use and stick with one medication but can also see scenarios why that would not happen. Each medication we give has a chance at having a reaction- good to point out which ones have higher incidences and maintain our awareness of potential complications.
2) Rocuronium has a faster onset of action so I can see why providers still use it. Starting 3 cases in the morning at the same time I can see the draw for our attending to want to use something fast acting- so why not Succinylcholine? Overall I think it is provider preference. Good to be well informed so we can make safer choices. Another good article-keeps us thinking.
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Post by cvelarde on Aug 31, 2018 14:22:44 GMT -5
I use rocuronium regularly because of its reliability and the reversal with sugammadex. The article sheds light on the possibility of an allergic reaction and for practioners to recognize rocuronium triggering a possible allergic response. The fact that vecuronium does not cause as much allergic responses as Rocuronium would lend someone to use it more that rocuronium. However the quicker onset and familiarity of usage makes roc a better choice for muscle relaxant for me. I think the article sheds light that roc can be the triggering agent for an allergic reaction and not just antibiotics. Do I mix the roc and vec? I try not to but sometimes roc is not available and vec was in my drawer at the time. I do not routinely mix roc and vec but stay with one to better ascertain if an allergic reaction occurs which agent it might be.
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