Prevention of awakening signs after rapid-sequence intubation: a randomized study

Jaffrelot, Morgan; Jendrin, Joel; Floch, Yolande; Lockey, David; Jabre, Patricia; Vergne, Muriel; Lapostolle, Frédéric; Galinski, Michel; Adnet, Frédéric

doi:10.1016/j.ajem.2006.09.016

« Previous Next »American Journal of Emergency Medicine
Volume 25, Issue 5 , Pages 529-534, June 2007

Prevention of awakening signs after rapid-sequence intubation: a randomized study

Morgan Jaffrelot, MD
- Samu 29 and Emergency Department, University Hospital, 29200 Brest, France
Joel Jendrin, MD
- Samu 44 and Emergency Department, University Hospital, 44000 Nantes, France
Yolande Floch, MD
- Emergency Department, Quimpert Hospital, 29000 Quimpert, France
David Lockey, MD
- London Helicopter Emergency Medical Service, Royal London Hospital, E1 1BB London, UK
Patricia Jabre, MD
- Samu 93, EA 3409, University Avicenne Hospital, 93000 Bobigny, France
Muriel Vergne, MD
- Samu 29 and Emergency Department, University Hospital, 29200 Brest, France
Frédéric Lapostolle, MD
- Samu 93, EA 3409, University Avicenne Hospital, 93000 Bobigny, France
Michel Galinski, MD
- Samu 93, EA 3409, University Avicenne Hospital, 93000 Bobigny, France
Frédéric Adnet, MD, PhD
- Samu 93, EA 3409, University Avicenne Hospital, 93000 Bobigny, France
- Corresponding author. Samu 93-EA 3409, Hopital Avicenne, 93000 Bobigny, France. Tel.: +33 1 48 96 44 08.

Received 30 August 2006; received in revised form 28 September 2006; accepted 29 September 2006.

Abstract

Background

This study aimed to establish the incidence of signs of inadequate sedation after rapid-sequence intubation (RSI) and to determine whether a supplementary bolus of induction agent decreases these signs.

Methods

A randomized, double-blind trial design was used. Patients were randomly assigned to 1 of 2 treatments: RSI plus etomidate bolus followed by continuous sedative infusion (ETO group) or RSI plus placebo followed by continuous sedative infusion (placebo group). The primary outcome measure was a composite sedation score measured 6 minutes after induction. The components of the score were the Ramsay sedation score, the presence of cough or pulling at endotracheal (ET) tube, jaw relaxation, motor activity, and eye opening. The total score (0-10) was the sum of the 5 components.

Results

There were 21 patients in the ETO group and 20 patients in the placebo group. The percentage of patients presenting with at least 1 sign of awareness was 43% in the ETO group and 65% in the placebo group (P = .16) 6 minutes after induction. The sedation score was significantly higher at 6 minutes in the placebo group compared with the ETO group (2.4 ± 2.9 vs 0.9 ± 1.4; P < .05). The use of additional sedative drugs during the observation period was 43% (9/21) in the ETO group compared with 55% (11/20) in the placebo group (P = .44).

Conclusions

This study demonstrated that some patients have signs of inadequate sedation after RSI. These signs may be partially prevented by a supplementary dose of an induction agent but other supplementary sedation seems necessary.