Rocuronium vs Succinylcholine: Emergency Airway Management of the COVID-19 Patient

Abstract

Tracheal Intubation is routinely performed in many settings.  Anesthesia providers are experts in this procedure.  Determination for the best possible approach for tracheal intubation include patient and provider specific considerations.  Severe acute respiratory syndrome-coronavirus-2 (SARS CoV-2) infection has led to the COVID-19 pandemic.  SARS CoV-2 is a highly contagious RNA virus that has caused widespread infections, severe respiratory disease, and deaths.  The purpose of this article is to describe the airway management currently recommended in Germany as well as the United States, the multi-systems pathophysiologic complications of these patients, and review the need for minimum airway manipulation prior to intubation of the trachea.  Further, this article discusses the pharmacologic options that are available for muscle relaxation during rapid sequence induction.  A review of the literature was performed.  Further, some authors of this article have actively participated in airway management of COVID-19 patients.  Available literature and guidelines suggest that rapid sequence induction with minimal airway manipulation is superior to standard induction. The article suggests that appropriate doses of rocuronium with an option of sugammadex reversal is a safer and superior choice to succinylcholine.