Rocuronium combined with i.v. lidocaine for rapid tracheal intubation

Yörükoğlu, Dilek; Asik, Yusuf; Ökten, Feyhan

doi:10.1034/j.1399-6576.2003.00086.x

Cited by 29 publications

(27 citation statements)

References 24 publications

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“…Rocuronium is a non-depolarizing, aminosteroid, neuromuscular blocker with an intermediate duration but fast onset of action, which differentiates it from the other non-depolarizing blockers and makes it an alternative agent to succinylcholine in situations of rapid-sequence induction [12][13][14] . The aim of this study was to evaluate, in an experimental model, the effects of procainamide in the neuromuscular transmission and its influence on the neuromuscular blockade produced by rocuronium and to investigate the probable mechanism of the interaction between procainamide and rocuronium.…”

Section: Influence Of Procainamide On the Neuromuscular Blockade Causmentioning

confidence: 99%

“…A potencialização dos efeitos da d-tubocurarina pela procainamida tem sido demonstrada 11 , porém ainda não existem estudos comparativos para demonstrar a interação da procainamida com outros bloqueadores neuromusculares atualmente empregados na prática clínica. O rocurônio é um bloqueador neuromuscular não-despolarizante aminoesteróide, com duração de ação intermediá-ria mas rápido início, característica que o diferencia dos demais bloqueadores não-despolarizantes e o torna um agente alternativo para a succinilcolina em situações de indução de seqüência rápida [12][13][14] . O objetivo deste estudo foi avaliar, em modelo experimental, o efeito da procainamida na transmissão neuromuscular e a sua influência no bloqueio neuromuscular produzido pelo rocurônio, investigando ainda o provável mecanismo da interação procainamida e rocurônio.…”

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Influência da procainamida sobre o bloqueio neuromuscular produzido pelo rocurônio e investigação sobre o mecanismo de ação da procainamida na junção neuromuscular

Martins¹,

Loyola²,

Braga³

2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:A potencialização da procainamida sobre o bloqueio neuromuscular produzido pela d-tubocurarina já está comprovada, porém o mecanismo é controverso. O objetivo do estudo foi avaliar a influência da procainamida no bloqueio neuromuscular produzido pelo rocurônio e investigar os mecanismos desta interação. MÉTODO: Foram utilizados 15 ratos (250 a 300 g) em preparação descrita por Bülbring. Formaram-se os seguintes grupos (n = 5 cada): procainamida -20 µg.mL -1 (Grupo I); rocurônio -4 µg.mL -1 (Grupo II) e rocurônio -4 µg.mL -1 e procainamida -20 µg.mL -1 (Grupo III). Avaliaram-se: 1) a amplitude das contrações musculares sob estimulação indireta em cada grupo, antes e após a adição dos fármacos; 2) os potenciais de placa terminal em miniatura (PPTM); 3) a eficácia da 4-aminopiridina na reversão do bloqueio neuromuscular. O mecanismo da interação foi estudado em Biventer cervicis (n = 5) e diafragma de rato desnervado (n = 5), observando-se a influência da procainamida na resposta à acetilcolina antes e após a adição da procainamida. RESULTADOS: A procainamida isoladamente não alterou as respostas neuromusculares. O bloqueio produzido com o Grupo III foi de 68,6% ± 7,1%, com diferença significativa (p = 0,0067) em relação ao Grupo II (10,4% ± 4,5%), revertido pela 4-aminopiridina. A procainamida ocasionou aumento na freqüência dos PPTM, seguido de bloqueio revertido pela 4-aminopiridina. Em Biventer cervicis a procainamida aumentou a resposta à ação de contração da acetilcolina, resultado não observado com o diafragma desnervado. CONCLUSÕES: A procainamida potencializou o bloqueio produzido pelo rocurônio. As alterações observadas com PPTM e Biventer cervicis identificaram ação pré-sináptica. O antagonismo da 4-aminopiridina sobre o bloqueio dos PPTM sugeriu dessensibilização dos receptores pela procainamida. Unitermos: ANIMAL: rato; ANTIARRÍTMICOS: procainamida; BLO-QUEADORES NEUROMUSCULARES, Não-despolarizantes: rocurônio; DROGAS: interação. SUMMARYMartins TD, Loyola YCS, Braga AFA -Influence of Procainamide on the Neuromuscular Blockade Caused by Rocuronium and Investigation on the Mechanism of Action of Procainamide on the Neuromuscular Junction. BACKGROUND AND OBJECTIVES: It has already been proved that procainamide potentiates the neuromuscular blockade of d-tubocurarine; however, the mechanism of this potentiation is controversial. The aim of this study was to assess the influence of procainamide on the neuromuscular blockade produced by rocuronium and investigate the mechanisms of this interaction. METHODS: Fifteen rats (250 to 300 g) were used in the preparation described by Bülbring. They were divided in three groups (n = 5 each): procainamide -20 µg.mL -1 (Group I); rocuronium -4 µg.mL -1 (Group II); and rocuronium -4 µg.mL -1 and procainamide -20 µg.mL -1 (Group III). The following parameters were evaluated: 1) amplitude of muscle contractions under indirect stimulation, before and after the administration of the drugs; 2) miniature end plate potentials (MEPPs); and 3) the effic...

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Section: Influence Of Procainamide On the Neuromuscular Blockade Causmentioning

confidence: 99%

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Influência da procainamida sobre o bloqueio neuromuscular produzido pelo rocurônio e investigação sobre o mecanismo de ação da procainamida na junção neuromuscular

Martins¹,

Loyola²,

Braga³

2007

Rev. Bras. Anestesiol.

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“…There was no significant change in pulse rate in vecuronium group but rocuronium group shows a significant change in pulse rate. Yorukoglu D et al, 18 observed that with rocuronium mean arterial blood pressure decreased after induction of anesthesia ( P<0.01) compared with baseline and increased significantly after tracheal intubation compared with the levels after induction of anesthesia (P<0.01). Schramm WM et al, 19 concluded in their study that patients in the Rocuronium group showed significant increase in heart rate that might be due to a vagal blocking effect.…”

Section: Discussionmentioning

confidence: 99%

“…Our study is consistent with several studies like. Booth MG et al, 14 Robertson EN et al, 15 Neilson K et al, 16 Misra M. N. et al, 17 Yorukoglu D et al, 18 and Schramm WM et al 19 Booth MG et al, 14 found increased heart rate by 36% in the Rocuronium group during the first minute following injection of Rocuronium, but remained stable in those patients who received Vecuronium. Robertson EN et al, 15 observed that rocuronium caused a 10-15% rise in mean arterial pressure and 5-10 % rise in heart rate whereas Vecuronium had no significant cardiovascular effects.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study to Evaluate the Efficacy of Rocuronium and Vecuronium for Rapid Sequence Intubation in Adults

Dwivedi¹,

Kaur²,

Jindal³

et al. 2015

jemds

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AIMS AND OBJECTIVES:To determine the efficacy of Rocuronium and Vecuroniumthe two newer non depolarizing neuromuscular blocking agents for rapid sequence intubation in adults undergoing surgical operations. MATERIAL AND METHOD: The present study was conducted on 60 healthy adult patients of ASA grade I and II, of either sex, requiring intubation for various surgical operations. Patients were randomly divided into 2 groups of 30 each: GROUP I (n=30) received i.v 1.2mg/kg body wt. of Rocuronium. GROUP II (n= 30) received i.v 0.15mg/kg body wt of Vecuronium. Intubation done at 60 seconds in both the groups. RESULTS: Excellent intubating conditions were achieved in almost 66% of patients whereas 33% had good intubating conditions in group I. On the other hand only 10% of patients showed excellent intubating conditions whereas majority (56%) showed good intubating conditions in group II. Both the groups showed significant increase in heart rate 1 min after intubation. In rocuronium group this increase in heart rate was significant at 3 min as well. CONCLUSION: Intubating conditions for rapid sequence intubation are significantly better with rocuronium group. Rocuronium may be considered a suitable alternative for succinylcholine especially in patients who are at risk of adverse effects of succinylcholine. Rocuronium and Vecuronium are haemodynamically stable drugs with no significant adverse effects. KEYWORDS: Rocuronium, Vecuronium, Succinylcholine, Rapid sequence intubation, Hemodynamic parameter. INTRODUCTION:Rapid endotracheal intubation is a lifesaving procedure of securing the airway in critically ill and injured patients as it results in rapid unconsciousness and paralysis in patients who are not fasting and are at risk of vomiting and aspiration. 1 Rapid sequence intubation (RSI) minimizes the time between the loss of consciousness and tracheal intubation. Preoxygenation is a standard component of RSI. 2 Preoxygenation on high fresh gas flows of 100% oxygen via face mask with a good mask fit for 3 to 5 minutes is recommended. Alternatively, a series of 4 vital capacity breaths of 100% oxygen may be used in an emergency. 3,4 The present study was undertaken to study the efficacy of Rocuronium, a newer nondepolarizing muscle relaxant in the dose of 1.2mg/kg and compare it with Vecuronium, 0.15mg/kg for rapid sequence intubation in adults.

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“…In our study, there was no significant difference between the groups. Yörükoğlu et al (19) evaluated the intubating conditions and hemodynamic changes associated with rocuronium and succinylcholine, after 2 mg kg -1 propofol induction. In that study, no significant difference was found in the HR values of patients, who were given 1.5 mg kg -1 lidocaine plus rocuronium.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effect of Different Concentrations of Rocuronium on Injection Pain and Haemodynamics Using Isolated Forearm Technique

Erbabacan¹,

Köksal²,

Tütüncü³

et al. 2013

Turk J Anesth Reanim

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Objective: We aimed to evaluate Visual-Analogue-Scale (VAS) scores, hand-withdrawal, rash and skin eruptions after injections of different concentrations of rocuronium in intubation doses in alert patients using the isolated-forearm technique.Methods: Eighty ASA I-II patients were included in a randomized, controlled, single-blinded study. Two 20 G cannulas were inserted into the dorsum of the left and right hand in each patient. A tourniquet was applied to the left arm and inflated to 50 mm Hg above the patient's systolic blood pressure. Group 1 (n=20) received 2.5 mg mL -1 rocuronium diluted with 0.9% NaCl, Group 2 (n=20) received 5 mg mL -1 rocuronium diluted with 0.9% NaCl, Group 3 (n=20) received 10 mg mL -1 rocuronium and 0.4 mg mL -1 lidocaine mixture, and Group 4 (n=20) received 10 mg mL -1 rocuronium via a cannula on the left hand, provided that a dose of 0.6 mg mL -1 were given to all groups of patients. VAS 0 -VAS 60 values, hand-withdrawal, rash and skin eruptions were assessed in patients who were administered rocuronium but not under the effects of hypnotic or neuromuscular agents. Hemodynamic values were recorded both before and after the administration of hypnotic-neuromuscular agents.Results: VAS0 values were significantly higher in Group 4 when compared to Groups 1, 2 and 3 (p=0.032). No significant difference was observed between VAS0 and VAS60 values in Groups 1, 2 and 3. In Group 4, VAS 0 values were significantly higher than VAS 60 values (p=0.003). No significant difference was observed between groups in terms of side effects and hemodynamic values. Conclusion:In conclusion, we determined that using rocuronium diluted with 0.9% NaCl was more effective in preventing injection pain than using a rocuronium-lidocaine mixture.Key Words: Rocuronium, intravenous injection, pain AbstractThe patient was transferred to the operating room, and two 20-gauge cannulas were placed at the back of the patient's right and left hands at one attempt without causing any hematoma and 4 mL kg -1 of 0.9% NaCl infusion was started from the right hand. Age, weight and gender of the patients were recorded, and as a standard procedure ECG, SpO 2 , non-invasive arterial pressure monitoring was performed (Datex Ohmeda S/5 Avance) in the operating room. Patients were randomized into 4 groups. Group 1 (n=20) received 2.5 mg mL -1 rocuronium diluted with 0.9% NaCl, Group 2 (n=20) received 5 mg mL -1 rocuronium diluted with 0.9% NaCl, Group 3 (n=20) received a mixture of 10 mg mL -1 rocuronium and 0.4 mg mL -1 lidocaine, and Group 4 (n=20) received 10 mg mL -1 rocuronium, providing a total dose of 0.6 mg kg -1 in all groups. No analgesics were administered before rocuronium application. Drugs were prepared in 20 mL syringes by an anaesthetist other than the anaesthetist who would administer the drug. In order to provide double blind testing, the syringes were covered with a non-transparent foil in order to keep the anaesthetist who administered the drug, unaware about the concentration and content of the drug.In order to p...

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Rocuronium combined with i.v. lidocaine for rapid tracheal intubation

Abstract: The combination of lidocaine (1.5 mg kg(-1)) and low-dose rocuronium (0.6 mg kg(-1)) along with propofol is clinically equivalent to succinylcholine, improves intubating conditions in 60 s and effectively blocks increases in heart rate after intubation.

Cited by 29 publications

References 24 publications

Influência da procainamida sobre o bloqueio neuromuscular produzido pelo rocurônio e investigação sobre o mecanismo de ação da procainamida na junção neuromuscular

Influência da procainamida sobre o bloqueio neuromuscular produzido pelo rocurônio e investigação sobre o mecanismo de ação da procainamida na junção neuromuscular

A Comparative Study to Evaluate the Efficacy of Rocuronium and Vecuronium for Rapid Sequence Intubation in Adults

Comparison of the Effect of Different Concentrations of Rocuronium on Injection Pain and Haemodynamics Using Isolated Forearm Technique

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