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

  • Ryan Shores University of North Florida
  • Katherine Fowler University of North Florida
  • John McDonough University of North Florida
  • Amy Suralis
  • Denise Scindele Regionale Kliniken Holding, RKH Akademie
  • Tilman Müller-Wolff Regionale Kliniken Holding, RKH Akademie


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.

Author Biographies

Katherine Fowler, University of North Florida

University of North FloridaJacksonville/FL/USAAssistant Professor- Nurse AnesthesiologyCoordinator of Clinical EducationUniversity of North Florida- School of Nursing

John McDonough, University of North Florida

Professor-University of North Florida

Program Director, UNF Nurse Anesthesiology Program

Amy Suralis

Amy Suralis is a CRNA who graduated in 2019.  She is a staff CRNA at Memorial Hospital in Jacksonville, FL.  She also recently volunteered and served time as an APRN in a New York City Intensive Care Unit.


Denise Scindele, Regionale Kliniken Holding, RKH Akademie

Program Director, Specialization Program in Anesthesiology and ICU NursingRegionale Kliniken Holding, RKH AkademieLudwigsburg, Germany

How to Cite
SHORES, Ryan et al. Rocuronium vs Succinylcholine: Emergency Airway Management of the COVID-19 Patient. Anesthesia eJournal, [S.l.], v. 8, n. 2, p. 27-31, mar. 2021. ISSN 2333-2611. Available at: <>. Date accessed: 09 dec. 2021.