Choice of the muscle relaxant for rapid-sequence induction

Sparr, H. J.

doi:10.1046/j.1365-2346.2001.00013.x

Cited by 8 publications

(12 citation statements)

References 34 publications

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“…While these few seconds do not make much difference in the usual clinical practice, they can be helpful when rapid intubation is important. In fact, this rapid onset approaches that of succinylcholine [1], a finding reported by others in this supplement [5][6][7].…”

Section: Rapid Onsetsupporting

confidence: 71%

Rapacuronium: first experience in clinical practice

Bartkowski¹,

Witkowski²

2001

Eur J Anaesthesiol

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Rapacuronium is a new non-depolarizing relaxant with a fast onset and rapid recovery. It was approved for the market in the United States in August 1999. The reasons for its acceptance in practice and the niche it fills are the subject of this review. Rapacuronium has been accepted wherever rapid onset and short duration of action are advantageous. It has received the greatest acceptance in brief outpatient procedures that require tracheal intubation. The average time of recovery to a train-of-four ratio of 80% is about 25 min after a usual intubating dose of 1.5 mg kg À1 , when block is reversed. Its rapid onset has led some to use it in rapid-sequence induction, but the exact place in this scenario is still being defined. Its spontaneous recovery is rapid enough that many practitioners do not reverse the block if the procedure is long enough. Data suggest that this is reasonable after 60 min and may even be earlier, even 30 min, if verified by monitoring. The main adverse effects of rapacuronium are bronchospasm, hypotension and tachycardia. Of these, only bronchospasm has had significant clinical impact. These effects are dose related and the recommended dose of 1.5 mg kg À1 may keep problems to a minimum. Because rapacuronium is a new drug with unique properties its use gradually increased in its first year. Because of the problems associated with succinylcholine, rapacuronium may have advantages for brief outpatient procedures and in cases where rapid termination of block is desired, provided its adverse effects can be minimized.

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Section: Rapid Onsetsupporting

confidence: 71%

Rapacuronium: first experience in clinical practice

Bartkowski¹,

Witkowski²

2001

Eur J Anaesthesiol

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“…In a review of safety aspects in 1300 patients, the incidence of bronchospasm was determined to be 3.4% with an 8.0% frequency of all side-effects [32]. The incidence of pulmonary side-effects is, however, higher in recent reports in patients undergoing rapid-sequence induction, and appears to be dose-related [26]. An incidence of 11-18% has been reported in these studies after 1.5-2.5 mg kg À1 doses.…”

Section: Safety and Tolerabilitymentioning

confidence: 99%

Rapacuronium: clinical pharmacology

Mirakhur

McCourt

2001

European Journal of Anaesthesiology

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The need for a rapid-acting non-depolarizing neuromuscular blocking agent with a short duration of action resulted in the synthesis of rapacuronium. The onset of maximum block with rapacuronium occurs in 60-90 s with doses of 1.5-2.5 mg kg À1 with a duration of clinical relaxation of 15-30 min. Rapacuronium provides clinically acceptable intubating conditions in 60 s in a majority of patients with these doses, although the conditions are somewhat inferior to those obtained with succinylcholine in lightly anaesthetized patients, such as those undergoing a rapid-sequence induction. The main drawbacks of rapacuronium are the occurrence of dose-related pulmonary side-effects (increased airway pressure and/or overt bronchospasm) and hypotension and tachycardia. The cause of pulmonary side-effects is not certain but these have been serious enough to make its worldwide introduction doubtful.

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“…The use of rapacuronium for facilitating intubation during rapid‐sequence induction of anaesthesia is discussed by Sparr elsewhere in this issue [26].…”

Section: Intubating Conditionsmentioning

confidence: 99%

“…In a review of safety aspects in 1300 patients, the incidence of bronchospasm was determined to be 3.4% with an 8.0% frequency of all side‐effects [32]. The incidence of pulmonary side‐effects is, however, higher in recent reports in patients undergoing rapid‐sequence induction, and appears to be dose‐related [26]. An incidence of 11–18% has been reported in these studies after 1.5–2.5 mg kg −1 doses.…”

Section: Safety and Tolerabilitymentioning

confidence: 99%

Rapacuronium: clinical pharmacology

Mirakhur

McCourt

2001

Eur J Anaesthesiol

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Summary The need for a rapid‐acting non‐depolarizing neuromuscular blocking agent with a short duration of action resulted in the synthesis of rapacuronium. The onset of maximum block with rapacuronium occurs in 60–90 s with doses of 1.5–2.5 mg kg−1 with a duration of clinical relaxation of 15–30 min. Rapacuronium provides clinically acceptable intubating conditions in 60 s in a majority of patients with these doses, although the conditions are somewhat inferior to those obtained with succinylcholine in lightly anaesthetized patients, such as those undergoing a rapid‐sequence induction. The main drawbacks of rapacuronium are the occurrence of dose‐related pulmonary side‐effects (increased airway pressure and/or overt bronchospasm) and hypotension and tachycardia. The cause of pulmonary side‐effects is not certain but these have been serious enough to make its worldwide introduction doubtful.

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Choice of the muscle relaxant for rapid-sequence induction

Cited by 8 publications

References 34 publications

Rapacuronium: first experience in clinical practice

Rapacuronium: first experience in clinical practice

Rapacuronium: clinical pharmacology

Rapacuronium: clinical pharmacology

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