So Josh's post yesterday (Rocketamine vs. keturonium for rapid sequence intubation) sparked much controversy and comment. I wanted to wade into the conflict, hence this wee.

Rocuronium Administration-Prior to Sedative

Administering roc as first drug is a variation of the timing principle demonstrated in a bunch of studies RCTs, here are 4 of them:

* http://www.ncbi.nlm.nih.gov/pubmed/9195356

* http://www.ncbi.nlm.nih.gov/pubmed/9585312

* http://www.ncbi.nlm.nih.gov/pubmed/7923516

* https://www.ncbi.nlm.nih.gov/pubmed/21547177

The most effective way to administer the med is actually to administer the sedative 15 sec after the roc, but most do not go that far. An easier to justify method is:

* Roc

* Induction agent

* Flush

This is my method for etomidate or propofol. For ketamine, I prefer DSI-type administration.

Update

* Driver et al. did an RCT https://doi.org/10.1111/acem.13723

Listen to the Wee to Hear my Thoughts...