2026 Southeastern Residency Conference

Study Objective: To pragmatically assess rocuronium dosing practices for emergency department intubation procedural outcomes and post-intubation sedation practices. 
Methods: We conducted a retrospective, single-center, observational study of adult patients who received rocuronium for intubation in the emergency department at an academic medical center between January 1st, 2022, and December 31st, 2024. Rocuronium doses were categorized as less than 0.6 mg/kg (low-dose), 0.6 to 1.2 mg/kg (intermediate-dose), or greater than 1.2 mg/kg (high-dose). Secondary outcomes included reversal agent use, first-pass intubation failure, intubation indication, intubating service, dosing year, and induction agent selection. Subgroup analysis evaluated post-intubation sedation timing and practices among patients who received either intermediate-dose or high-dose. Categorical variables are reported as counts and percentages, and continuous variables are summarized using descriptive statistics. 
Results: A total of 237 patients met inclusion criteria. Most patients received doses within 0.6 to 1.2 mg/kg (189 (79.7%)), whereas 18 patients (7.6%) received low-dose and 30 patients (12.7%) received high-dose. First-pass intubation failure was greatest in the intermediate-dose group, occurring in 45 patients (23.8%) versus 3 patients (10%) in the high-dose group. Emergency medicine clinicians performed the majority of intubations (82.3%). The median time to sedation initiation was 5 minutes for the low-dose group, 6 minutes for the intermediate-dose group, and 3 minutes for the high dose group. Fentanyl was administered in 100% of patients in the higher-dose group compared with 83.3%% of patients in the low-dose group and 79.6% in the intermediate-dose group. While propofol was administered in 31% of patients who received higher-doses compared to 33.3 % and 57.5% respectively. Overall, a majority of patients received an infusion (124 (52%)) as the post-intubation sedation method with bolus plus infusion (94 (40%)) being the next most common method. 
Conclusion: The majority of patients received doses of rocuronium within the 0.6 to 1.2 mg/kg range, consistent with recommendations in available literature. Lower observed first-pass failure rates among patients receiving lower rocuronium doses, however, the smaller sample sizes in the low and high-dose groups limit the significance of differences in observed event rates. Post-intubation sedation practices varied across dosing groups, particularly with respect to fentanyl and propofol utilization.