Rocuronium priming for tracheal intubation in COVID‐19 patients

Priming doses of non‐depolarising neuromuscular blocking drugs given before administration of anaesthetic agents have been used to hasten the onset of neuromuscular blockade. In the settings of coronavirus disease 2019 (COVID‐19), this could be used to reduce the apnoeic, and potentially aerosol‐generating, window. To our knowledge, we report the first cases of tracheal intubation with rocuronium for COVID‐19 using the priming principle. Both patients needed their tracheas intubated for severe hypoxia using a rapid sequence induction technique with a priming dose of rocuronium. Despite adequate pre‐oxygenation a sudden, unexpected fall in arterial oxygen saturations was observed in both patients after administration of a priming dose of 2 mg of rocuronium. Clinicians should consider this possible risk associated with priming doses of neuromuscular blocking drugs in the management of patients with respiratory failure due to COVID‐19.

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