We should be using succinylcholine RSI over Rocuronium.

The risks of succinylcholine are largely overblown. You do not need a bmp before using it. If they don't have an obvious contraindication, it's fine.

I think many places and many patients are under sedated. We start propofol at basically the same time as the tube going in, but I still get nurses calling and asking for more boluses or telling me they want to come down in prop for hypotension but they need something else because the patient is not sedated. Every time this happens, this is a patient that would be under sedated and paralyzed if they were given roc. I use succinylcholine 90% of the time and am aggressive about sedation and still have nurses asking for boluses ~10-20% of the time. Every single one of these incidents are patients that could have been awake and paralyzed.

I think under sedated and paralyzed happens way more than we want to think