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Rocuronium and Succinylcholine: A Comparison of Intubating Conditions in a Rapid Sequence Induction
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Background and Aim: Succinylcholine is the gold standard for rapid sequence induction of anesthesia. An alternative neuromuscular blocker (NMB) with comparable quick onset and short duration is desirable in situations where its use is contraindicated. Rocuronium offers promise especially after the introduction of sugammadex. There is still some concern regarding the quality of intubating conditions provided at 60 seconds. Methods and Materials: Forty patients undergoing elective surgery under general anesthesia were randomly divided into two groups. For intubation Group R received i.v. rocuronium bromide 0.6 mg/kg and Group S received succinylcholine 1 mg/kg. Rapid sequence induction was performed with injection thiopentone 5 mg/kg followed immediately by the NMB according to the assigned group. Intubation was performed one minute after the NMB and intubating conditions assessed and graded on a four-point scale: Excellent = jaw relaxed, vocal cords apart and immobile, no diaphragmatic movement; Good = jaw relaxed, vocal cords apart and immobile, some diaphragmatic movement; Poor = jaw relaxed, vocal cords moving, bucking; Inadequate = jaw not relaxed, vocal cords adducted, uncontrolled cough/bucking. Good and excellent conditions were together taken as clinically acceptable. Results: All the 20 intubations performed in group S and only 11 in Group R were rated as excellent one minute after the injection of muscle relaxant (p < 0.001). They were rated clinically acceptable in 18 patients in Group R compared to 20 patients in Group S (p > 0.05). Conclusions: Rocuronium provides clinically acceptable intubating conditions similiar to succinylcholine at 60 seconds and can be considered a safe alternative for rapid tracheal intubation in select situations where succinylcholine is contraindicated.
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Background and Aim: Succinylcholine is the gold standard for rapid sequence induction of anesthesia. An alternative neuromuscular blocker (NMB) with comparable quick onset and short duration is desirable in situations where its use is contraindicated. Rocuronium offers promise especially after the introduction of sugammadex. There is still some concern regarding the quality of intubating conditions provided at 60 seconds. Methods and Materials: Forty patients undergoing elective surgery under general anesthesia were randomly divided into two groups. For intubation Group R received i.v. rocuronium bromide 0.6 mg/kg and Group S received succinylcholine 1 mg/kg. Rapid sequence induction was performed with injection thiopentone 5 mg/kg followed immediately by the NMB according to the assigned group. Intubation was performed one minute after the NMB and intubating conditions assessed and graded on a four-point scale: Excellent = jaw relaxed, vocal cords apart and immobile, no diaphragmatic movement; Good = jaw relaxed, vocal cords apart and immobile, some diaphragmatic movement; Poor = jaw relaxed, vocal cords moving, bucking; Inadequate = jaw not relaxed, vocal cords adducted, uncontrolled cough/bucking. Good and excellent conditions were together taken as clinically acceptable. Results: All the 20 intubations performed in group S and only 11 in Group R were rated as excellent one minute after the injection of muscle relaxant (p < 0.001). They were rated clinically acceptable in 18 patients in Group R compared to 20 patients in Group S (p > 0.05). Conclusions: Rocuronium provides clinically acceptable intubating conditions similiar to succinylcholine at 60 seconds and can be considered a safe alternative for rapid tracheal intubation in select situations where succinylcholine is contraindicated.
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This page is a summary of: Rocuronium and Succinylcholine: A Comparison of Intubating Conditions in a Rapid Sequence Induction with Thiopentone, Indian Journal of Anaesthesia and Analgesia, January 2019, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.6519.46.
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