The Resus Room September 2026; papers of the month
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Sep 1, 2026 Three practical studies put emergency and prehospital care under the microscope. The discussion explores sedation after prehospital RSI, including variation in maintenance dosing and the potential role of infusions. It compares NEWS with shock index for trauma risk assessment, then examines whether higher rocuronium doses improve first-pass intubation success, including in obesity and hypoperfusion.
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How The Bolus Anaesthesia Study Selected Patients
- This retrospective study examined 101 blunt trauma patients aged 12 or older who had relatively preserved physiology before induction.
- Researchers excluded systolic pressure below 100 mmHg or shock index above 1 to focus on patients less likely to need deliberately light anaesthesia.
Bolus Anaesthesia Produced Wide Dose Variation
- Dosing varied substantially, with median exposure equivalent to 0.64 micrograms/kg/hour fentanyl and 0.028 mg/kg/hour midazolam.
- Eight patients received no maintenance sedative or analgesic for anaesthesia lasting 48–74 minutes, including four who received further paralysis.
Use Infusions To Reduce Sedation Variation
- Treat maintenance anaesthesia as a planned task rather than an improvised response to apparent need.
- Consider infusions to standardise delivery and reduce the cognitive burden of remembering repeated boluses during transport.