Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia

Abstract

SummaryThis study was designed to compare the tracheal intubating conditions during a rapid sequence induction of anaesthesia using rocuronium 0.6 (n ¼ 61) or 1.0 mg.kg ¹1 (n ¼ 130) or suxamethonium 1.0 mg.kg ¹1 (n ¼ 127) as the neuromuscular blocking drugs. Anaesthesia was induced with fentanyl 1-2 mg.kg ¹1 and thiopentone 5 mg.kg ¹1 (median dose) and intubating conditions were assessed 60 s after the administration of the neuromuscular blocking drug by an observer unaware of which drug had been given. Intubating conditions were graded on a threepoint scale as excellent, good or poor, the first two being considered clinically acceptable. The study was carried out in two parts. At the end of the first part a comparison between the two doses of rocuronium was carried out when at least 50 patients had been enrolled in each group. The results showed the intubating conditions to be significantly superior with the 1.0 mg.kg ¹1 dose of rocuronium (p < 0.01). Final comparison between the 1.0 mg.kg ¹1 doses of rocuronium and suxamethonium showed no significant difference in the incidence of acceptable intubations (96 and 97%, respectively). The incidence of excellent grade of intubations was, however, significantly higher with suxamethonium (80% vs. 65%; p ¼ 0.02). It is concluded that rocuronium 1.0 mg.kg ¹1 can be used as an alternative to suxamethonium 1.0 mg.kg ¹1 as part of a rapid sequence induction provided there is no anticipated difficulty in intubation. The clinical duration of this dose of rocuronium is, however, 50-60 min.

Comparison of sevoflurane and propofol with rocuronium for modified rapid‐sequence induction of anaesthesia

“…The lower doses were clearly inadequate and, while using a dose of 0.6 mg.kg ¹1 provided acceptable conditions in 90% of subjects, more time or a higher dose of rocuronium would be required for more uniformly excellent conditions. Similar findings have been reported by McCourt et al [3] when using thiopentone and rocuronium for facilitating a rapid-sequence induction.…”

“…The results in our study are slightly better than those reported by McCourt et al [3] using thiopentone and rocuronium 0.6 mg.kg ¹1 during a rapid-sequence induction, perhaps as a result of using propofol.…”

“…The induction was, however, modified as they did receive fentanyl 1 mg.kg ¹1 just before induction, as in previous studies assessing intubating conditions and suggested by recent guidelines [3,4]. Although the induction in the sevoflurane group was slower than in the propofol group, this was still accomplished within a reasonable time and without any episodes of desaturation in any patient.…”

“…Rocuronium, because of its rapid onset of action, has been suggested as an alternative to suxamethonium for use in rapid-sequence induction of anaesthesia [2,3]. Using a vital capacity technique, the speed of induction with sevoflurane has been shown to be almost as rapid as that of intravenous propofol [1].…”

Succinylcholine and Morbid Obesity: The Debate Continues…

“…Although its onset to paralysis is almost equivalent to succinylcholine, rocuronium has a much longer (30-50 min) duration of action [3]. For a normal weight surgical patient with a normal airway and a long safe apnea time (time from paralysis until oxyhemoglobin desaturation), rocuronium can be substituted for succinylcholine.…”