After the results of the recent poll “Which muscle relaxant do you usually use for RSI in ED patients”, that showed suxamethonium to be much more commonly used than rocuronium (I think I was the only person who voted for it!), I thought it might be useful to have a quiz on muscle relaxants. Please take the quiz – the results will be known only to you – and might surprise you! To revise the subject click here.
Muscle relaxants for RSI
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The choice of the best agent for RSI in the ED depends on rapdidity of onset and risk of adverse effects. Take the quiz and see which agent comes out on top.
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Hmm…… you might need to review the subject again.
Rocuronium has clear advantages over suxamethonium in important areas. It is equally rapid in onset, slightly more rapidly reversible with suggamadex than letting suxamethonium wear off, has fewer adverse effects and contraindications. If you are not already using rocuronium for RSI – try it!
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Good try – but might be worth looking at the subject again.
Rocuronium has clear advantages over suxamethonium in important areas. It is equally rapid in onset, slightly more rapidly reversible with suggamadex than letting suxamethonium wear off, has fewer adverse effects and contraindications. If you are not already using rocuronium for RSI – try it!
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Passed the quiz but there is still more to know.
Rocuronium has clear advantages over suxamethonium in important areas. It is equally rapid in onset, slightly more rapidly reversible with suggamadex than letting suxamethonium wear off, has fewer adverse effects and contraindications. If you are not already using rocuronium for RSI – try it!
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Well done.
Rocuronium has clear advantages over suxamethonium in important areas. It is equally rapid in onset, slightly more rapidly reversible with suggamadex than letting suxamethonium wear off, has fewer adverse effects and contraindications. If you are not already using rocuronium for RSI – try it!
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Love your work – well done.
Rocuronium has clear advantages over suxamethonium in important areas. It is equally rapid in onset, slightly more rapidly reversible with suggamadex than letting suxamethonium wear off, has fewer adverse effects and contraindications. If you are not already using rocuronium for RSI – try it!
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Question 1 of 6
1. Question
Which agent is the most likely to worsen hypoxia during RSI?
Correct
Suxamethonium is the most likely to cause hypoxia due to muscle fasciculation causing additional O2 consumption
Incorrect
Suxamethonium is the most likely to cause hypoxia due to muscle fasciculation causing additional O2 consumption
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Question 2 of 6
2. Question
At suitable doses, which agent provides the most rapid muscle relaxation suitable for intubation?
Correct
Time to relaxation following suitable doses (e.g. 1.5mg/kg) are very similar for rocuronium and suxamethonium.
Sux may be marginally quicker, so give yourself a point if you said it was!Incorrect
Time to relaxation following suitable doses (e.g. 1.5mg/kg) are very similar for rocuronium and suxamethonium.
Sux may be marginally quicker, so give yourself a point if you said it was! -
Question 3 of 6
3. Question
Which agent has the fewest potential adverse reactions?
Correct
Rocuronium has much fewer potential complications than suxamethonium, with atracurium and vecuronium having only slightly more potential complications (mostly allergy) than rocuronium.
Incorrect
Rocuronium has much fewer potential complications than suxamethonium, with atracurium and vecuronium having only slightly more potential complications (mostly allergy) than rocuronium.
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Question 4 of 6
4. Question
Which is the most rapidly reversed form of muscle relaxation?
Correct
Rapid reversal of rocuronium with suggamadex is slightly quicker than letting an intubating dose of suxamethonium wear off. Assuming someone knows where the sugammadex is of course……
Incorrect
Rapid reversal of rocuronium with suggamadex is slightly quicker than letting an intubating dose of suxamethonium wear off. Assuming someone knows where the sugammadex is of course……
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Question 5 of 6
5. Question
Which agent has the most contraindications?
Correct
Suxamethonium has the most contra-indications due to it’s capacity to cause hyperkalaemia, bradycardia and increase ocular and gastric pressures.
Incorrect
Suxamethonium has the most contra-indications due to it’s capacity to cause hyperkalaemia, bradycardia and increase ocular and gastric pressures.
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Question 6 of 6
6. Question
Which agent is the easiest to tell clinically that muscle relaxation has occurred
Correct
The end of suxamethonium induced fasciculations (in the small muscles (e.g. eyes), not just the big ones you can see!) indicates that paralysis has been obtained. This is the one advantage of suxamethonium over rocuronium, particularly in the patient with circulatory compromise and slower than normal onset of action. The adequacy of relaxation with the other agents is usually assessed by jaw muscle tone.
Incorrect
The end of suxamethonium induced fasciculations (in the small muscles (e.g. eyes), not just the big ones you can see!) indicates that paralysis has been obtained. This is the one advantage of suxamethonium over rocuronium, particularly in the patient with circulatory compromise and slower than normal onset of action. The adequacy of relaxation with the other agents is usually assessed by jaw muscle tone.