Priming Principle and Rapid Sequence Intubation With Non-Depolarising Muscle Relaxant Vecuronium Bromide

Abstract

BACKGROUND Succinylcholine cannot be used for rapid sequence intubation (RSI) in several situations due to associated side effects. Vecuronium bromide has faster onset of time among non-depolarising muscle relaxants and can offer safe alternative for RSI when the priming principle used. The aim of the study is to evaluate the intubating conditions and time required for rapid, smooth tracheal intubation using the "principle of priming" with non-depolarising muscle relaxant vecuronium bromide. The objective of the study was taken up with the primary objective of evaluating the different priming doses of vecuronium bromide at the time of intubation and the secondary objective of evaluating the intubation conditions. MATERIALS AND METHODS A study consisting of 60 patients of different age and of both sexes were divided into 3 groups to assess the intubation time and the intubation conditions using "priming principle" with vecuronium bromide. Group I consists of 20 patients who received a bolus dose of 0.1 mg/kg vecuronium, the mean intubating time was 149 seconds and in 70% of cases. In Group II, 20 patients received a priming dose of 0.015 mg/kg, intubating dose of 0.6 mg/kg with 5 minutes interval. Adequate intubating conditions were achieved in 96 seconds in 80% of cases. Group III consists of 20 patients who received a priming dose of 0.02 mg/kg and intubating dose of 0.08 mg/kg. Adequate intubating conditions were achieved in 63 seconds in all patients. Time of intubation was assessed using train-offour (TOF) stimuli and intubation conditions were compared as per Lemon et al, 1986. Settings and Design-This randomised, prospective, double-blind study was conducted in patients for abdominal, head and neck surgeries under general anaesthesia in the Department of Anaesthesia; SVRR Govt. General Hospital, Tirupati, AP. RESULTS The onset time of intubation was 149 ± 13 in Group I, 96 ± 12 in Group II and 63 ± 7.1 in Group III. Intubating conditions were clinically acceptable in all three groups. CONCLUSION This study concluded that vecuronium bromide can be used for rapid tracheal intubation (RSI) utilising "priming principle."

Effect of Two Different Priming Doses of Cisatracurium in Addition to its Bolus Dose- A Randomised Double-Blind Controlled Trial

“…Adequate intubating conditions were achieved in 63 seconds in all patients. 19 So, it can be seen that our observations are consistent with observations of Schmidt J et al, Duggappa et al, Veena et al and Rao MS et al That priming significantly reduces the onset time of NDMR and also this reduction is higher with higher priming doses.…”

“…In their study Rao MS et al found that intubating conditions were clinically acceptable in all three groups where two different priming doses were used in two groups and no priming was used in a group. 19 Study done by Sindhu K. Sridhar et al showed that intubating conditions were clinically acceptable in all three groups. Intubating conditions were compared by the Cooper scoring system.…”