Rocuronium bromide

Abstract

Rocuronium bromide Hypoxia: 2 case reportsIn a case series, a 67-year-old woman and 67-year-old man were described, who developed hypoxia during treatment with rocuronium bromide for tracheal intubation [routes not stated].Patient 1: The 67-year-old woman was admitted to the infectious disease ward following diagnosed with Coronavirus disease-19 (COVID-19). Four days later, regardless of the administration of 10 L/min oxygen via facemask, her arterial oxygen saturation was found to be 85%. She did not have respiratory distress and she was alert and orientated. Due to deterioration in her condition, a decision was made to intubate her trachea and ventilate her lungs. Therefore, ECG, noninvasive blood pressure and pulse oximetry monitoring were established. She was pre-oxygenated with 5 L/min oxygen for 5 minutes, which resulted in her arterial oxygen saturations reached 92%. Thereafter, she was started on rocuronium bromide [rocuronium] 2mg as a priming dose. Approximately, 3 minutes later, her oxygen saturation decreased to 80% without any diplopia. Immediately, she was administered with propofol for induction of general anaesthesia followed by rocuronium bromide 48mg to facilitate tracheal intubation [received a total dose of 0.95 mg.kg -1 ]. However, her oxygen saturation further decreased to 70%. Meanwhile, she was manually ventilated for approximately 3 minutes, which resulted in her oxygen saturation reached 95%. Later, she was intubated by a skilled front-line anaesthetist. Consequently, she was haemodynamically stable throughout the tracheal intubation procedure.Patient 2: The 67-year-old man was admitted to the infectious disease ward following diagnosed with Coronavirus disease-19 (COVID-19). Eight days later, his condition worsened and a decision of trachea intubation was made. Therefore, he was maintained on the arterial oxygen saturation of approximately 90% by administering 10 L/min of oxygen via facemask. He was alert and orientated without respiratory distress. Therefore, ECG, noninvasive blood pressure and pulse oximetry monitoring were established. He was pre-oxygenated with 5 L/min oxygen for 5 minutes, which resulted in his arterial oxygen saturations reached 92%. Thereafter, he was started on rocuronium bromide [rocuronium] 2mg as a priming dose. Approximately, 3 minutes later, his oxygen saturation decreased to 80%. Diplopia was not reported, but respiratory depression was observed. Immediately, he was administered with propofol for induction of general anaesthesia followed by rocuronium bromide 48mg to facilitate tracheal intubation [received a total dose of 0.67 mg.kg -1 ]. However, after approximately 60 seconds, his arterial oxygen saturation further decreased to 55%. Therefore, he proceeds directly to tracheal intubation by a skilled anaesthetist. Thereafter, he was haemodynamically stable throughout the procedure.