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BET 3: Suxamethonium (succinylcholine) for RSI and intubation in head injury

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Report by: Natalie May, ST5 Emergency Medicine/ST7 PEM

Search checked by: Kenneth Anderson, ST3 Emergency Medicine, University Hospital of South Manchester

Institution: Royal Manchester Children's Hospital

Clinical scenario

You are the middle grade doctor attending a patient with an isolated head injury in the Emergency Department. The GCS on arrival is now E2V2M4 (8/15). There is a history of vomiting en route to the hospital. The anaesthetist present agrees that the patient should be intubated following rapid sequence induction for CT scan; while you are pre-oxygenating another middle grade appears and helpfully reminds you that ‘suxamethonium will only increase this patient's intracranial pressure.’ You wonder whether the evidence is compelling enough to avoid suxamethonium altogether in patients with head injury.

Three-part question

In (patients with traumatic brain injury), does (suxamethonium) (significantly increase intracranial pressure)?

Search strategy

Ovid MEDLINE® 1948 to September 09 2011 EMBASE® 1980 to present.

Cochrane Database, exp Succinylcholine/ OR suxamethonium.mp OR depolarising muscle relaxant*.mp OR anectine.mp AND, exp Intracranial Pressure/ OR intracranial pressure.mp OR ICP.mp.

LIMIT TO, Humans, English Language

The references of review articles were also searched for articles relevant to the three-part question.

Search outcome

The MEDLINE search produced 33 papers, of which six was relevant to the three-part question. The EMBASE search produced six papers of which none was relevant to the …

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