Effects of pretreatment with different neuromuscular blocking agents on facilitation of intubation with rocuronium: A prospective randomized comparative study

Abstract

Background and Aims:Priming principle refers to administration of a small dose of non-depolarising blocker, which when followed by a large intubating dose produces a relatively rapid and profound blockade to ensure suitable conditions for endotracheal intubation. We aimed to compare the effects of rocuronium, vecuronium, and atracurium as “pretreatment” drugs on intubating conditions with rocuronium facilitated endotracheal intubation.Methods:This double-blinded, randomised controlled prospective study was carried out at a tertiary health care hospital on patients undergoing surgical procedures under general anaesthesia. They were randomly allocated into three groups (n = 35) by computer generated randomisation chart to receive either rocuronium (0.06 mg/kg body weight) (Group A); vecuronium (0.01 mg/kg body weight) (Group B) or, atracurium (0.05 mg/kg body weight) (Group C), followed by intubating dose (0.6 mg/kg body weight) of rocuronium. The haemodynamic parameters and intubating conditions were studied and statistically analysed by ANOVA test and Student's t-test as applicable using statistical package for the social sciences 16.0 for windows (SPSS Inc., Chicago, IL, USA).Results:Excellent intubating conditions were noted in maximum number of patients in Group C (97.41%). No significant differences were observed in the systolic blood pressure in all the three groups at all-time intervals. The mean arterial pressure rose significantly from baseline value to maximum, at ‘0’ min in all the groups; however, no significant difference was observed amongst the groups (P > 0.05).Conclusion:Pretreatment with rocuronium bromide can facilitate endotracheal intubation in 60 s irrespective of non-depolarising muscle relaxants used for priming; however, it cannot attenuate haemodynamic changes associated with laryngoscopy and intubation.

Efficacy of Rocuronium Priming Versus Pre-Treatment With Magnesium Sulphate During Rocuronium Intubation for Elective General Surgical Cases. A Randomised, Prospective, Double-Blinded Controlled Trial

“…DS Shashank et al evaluated the effects of pre-treatment with different non-depolarising neuromuscular blockers (Rocuronium vs. vecuronium vs. atracurium) on the facilitation of intubation and concluded that pre-treatment with rocuronium facilitated endotracheal intubation within 60 seconds when compared to other agents; however, it cannot attenuate haemodynamic changes associated with laryngoscopy and intubation. 14 Jing Dong, Lingqi Gao et al conducted a network metaanalysis on various pharmacological interventions for acceleration of the onset time of rocuronium and concluded that rocuronium priming, pre-treatment with ephedrine and pre-treatment with magnesium sulphate were all effective in accelerating the onset time of rocuronium with comparable efficacy. 15 However, they reported that due to heterogeneity of studies, more strict clinical trials are needed to derive concrete conclusions.…”

Effects of Priming on Onset Time and Intubating Conditions With Rocuronium- A Prospective Randomised Comparative Study

“…13 In his study, Susank et al used different neuromuscular blocking agents for priming and he found that priming can facilitate endotracheal intubation by rocuronium in 60 seconds irrespective of the neuromuscular blocking agent used. 14 Rao et al used a priming dose of 0.06 mg/kg followed by 0.54 mg/kg rocuronium in one group and 0.6 mg/kg rocuronium in the other group. The onset time of intubation was 50.6±45s in the priming group and 94.0±11.620 in the control group with excellent intubating conditions in both groups.…”

A prospective randomized study for comparison of onset time of intubation and intubating conditions using rocuronium with priming and without priming

“…The size of the priming dose and the time interval between priming and intubating dose are of fundamental importance in this principle in order to occupy the critical proportion of receptors and to maximize receptor occupancy and profound blockade. According to second theory, the priming dose blocks presynaptic nicotinic receptors, reducing the mobilization and release of acetylcholine to such extent that the intubating dose produces more rapid and profound neuromuscular blockade [4,6,10].…”

“…Priming principle is one of the techniques which requires administration of a small dose (10% of intubating dose) of non-depolarizing neuromuscular blocking agent followed by a large intubating dose after 2-4 min that produces a relatively rapid onset of neuromuscular blockade along with adequate intubating conditions for endotracheal intubation without undue prolongation of action or undesirable side effects. This technique is preferable in all patients who required rapid sequence intubation and in whom succinylcholine is contraindicated or undesirable [4][5][6][7][8]. In our study we have used rocuronium with intubating dose of 0.6 mg/kg (i.e.…”