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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, February 6, 2023

Remi vs NMB for RSI

JC St Emlyn’s - By Dan Horner - February 4, 2023
Lots of excellent literature out recently. We would heartily recommend a look at all the parallel releases from the SCCC 2023, including the CLOVERs trial and others. There has also been some great work on thromboprophylaxis in trauma which we will try and get to shortly. 
But first on the list, was this randomised controlled trial comparing conventional rapid sequence induction in patients with aspiration risk using neuromuscular blockade (NMB), to deep analgosedation with remifentanil. What’s this all about then? RSI has undergone enough changes recently thankyou very much. Most centres are still barely catching up. And now someone wants to drop neuromuscular blockade? Sounds bonkers….. 
Or does it? Many remifentanil proponents have long argued for its rapid onset efficacy in achieving adequate muscle relaxation to facilitate most things. The rapid offset also solves all those awkward problems of what to do if the view is not as expected, or you run into problems, or you just don’t like the cost of an emergency dose of sugammadex….