Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgia

Martin, René; Carrier, Joanne; Pirlet, Martine; Claprood, Yves; Tétrault, J. P.

doi:10.1007/bf03012701

Cited by 48 publications

(9 citation statements)

References 9 publications

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“…serious side effects [1] – [4] . To avoid these fasciculation related life threatening side effects caused by succinylcholine, more and more anesthesiologists have turned to use non-depolarizing muscle relaxants to facilitate intubation [5] , [6] . Many non-depolarizing muscle relaxants are currently used in clinical practice, but none of them can simultaneously satisfy the requirements of rapid onset, deep muscle relaxation, and rapid recovery for muscle relaxants to facilitate intubation as succinylcholine does [7] – [9] .…”

Section: Introductionmentioning

confidence: 99%

Pharmacological Interventions for Acceleration of the Onset Time of Rocuronium: A Meta-Analysis

Dong

Gao

et al. 2014

PLoS ONE

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BackgroundRocuronium is an acceptable alternative when succinylcholine is contraindicated for facilitating the endotracheal intubation. However, the onset time of rocuronium for good intubation condition is still slower than that condition of succinylcholine. This study systematically investigated the most efficacious pharmacological interventions for accelerating the onset time of rocuronium.MethodsMedline, Embase, Cochrane Library databases, www.clinicaltrials.gov, and hand searching from the reference lists of identified papers were searched for randomized controlled trials comparing drug interventions with placebo or another drug to shorten the onset time of rocuronium. Statistical analyses were performed using RevMan5.2 and ADDIS 1.16.5 softwares. Mean differences (MDs) with their 95% confidence intervals (95% CIs) were used to analyze the effects of drug interventions on the onset time of rocuronium.Results43 randomized controlled trials with 2,465 patients were analyzed. The average onset time of rocuronium was 102.4±24.9 s. Priming with rocuronium [Mean difference (MD) −21.0 s, 95% confidence interval (95% CI) (−27.6 to −14.3 s)], pretreatment with ephedrine [−22.3 s (−29.1 to −15.5 s)], pretreatment with magnesium sulphate [−28.2 s (−50.9 to −5.6 s)] were all effective in reducing the onset time of rocuronium. Statistical testing of indirect comparisons showed that rocuronium priming, pretreatment with ephedrine, and pretreatment with magnesium sulphate had the similar efficacy.ConclusionRocuronium priming, pretreatment with ephedrine, and pretreatment with magnesium sulphate were all effective in accelerating the onset time of rocuronium, and furthermore their efficacies were similar. Considering the convenience and efficacy, priming with rocuronium is recommended for accelerating the onset time of rocuronium. However, more strict clinical trials are still needed to reach a more solid conclusion due to the large heterogeneities exist among different studies.

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Section: Introductionmentioning

confidence: 99%

Pharmacological Interventions for Acceleration of the Onset Time of Rocuronium: A Meta-Analysis

Dong

Gao

et al. 2014

PLoS ONE

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“…The primary search and hand search of reference lists yielded 39 articles reporting 39 studies designed as RCTs. More detailed examination found that 23 RCTs did not meet the inclusion criteria of this review, including five that used children as subjects (21–25) and 18 that failed to use intubation conditions as outcome measures (16,26–42).…”

Section: Resultsmentioning

confidence: 99%

Succinylcholine or rocuronium? A meta-analysis of the effects on intubation conditions

Karcıoğlu

Arnold

Topaçoğlu

et al. 2006

International Journal of Clinical Practice

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This meta-analysis was undertaken to compare the effects of succinylcholine (SCH) and rocuronium (RCR) on endotracheal intubation (ETI) conditions. Eligible randomised controlled trials (RCTs) were identified via medline and a manual search of references. The frequencies of excellent and unacceptable ETI conditions in subjects receiving SCH 1.0-1.5 mg/kg and RCR 0.6-1.2 mg/kg were determined using standard statistical methods. Inclusion criteria were met by 16 RCTs, representing 1362 subjects. SCH was associated with a 17.7% increase (95% CI = 13-22) in the frequency of excellent ETI conditions and a 5.1% decrease (95% CI = -7.3 to -2.9) in the frequency of unacceptable ETI conditions, when compared with RCR. In the subgroup undergoing true rapid sequence intubation, SCH was associated with a 19.1% increase (95% CI = 13.7-24.5) in the frequency of excellent ETI conditions. SCH appears to be superior to RCR in creating excellent ETI conditions and avoiding unacceptable ETI conditions.

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“…Fasciculations after suxamethonium dose are common in adults but rarely observed in children. They can be prevented by small dose of rocuronium (0.06 mg·kg −1 ) injected 4 min before suxamethonium (30). Both fasciculations and muscle pain have not been regarded as a major problem in children.…”

Section: Fasciculations and Muscle Painmentioning

confidence: 99%

The place of suxamethonium in pediatric anesthesia

Rawicz

Brandom

Wolf

2009

Pediatric Anesthesia

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Summary Suxamethonium is a drug that promotes very strong views both for and against its use in the context of pediatric anesthesia. As such, the continuing debate is an excellent topic for a ‘Pro–Con’ debate. Despite ongoing efforts by drug companies, the popular view still remains that there is no single neuromuscular blocking drug that can match suxamethonium in terms of speed of onset of neuromuscular block and return of neuromuscular control. However, with this drug the balance of benefit vs risk and side effects are pivotal. Suxamethonium has significant adverse effects, some of which can be life threatening. This is particularly relevant for pediatric anesthesia because the spectrum of childhood diseases may expose susceptible individuals to an increased likelihood of adverse events compared with adults. Additionally, the concerns related to airway control in the infant may encourage the occasional pediatric anesthetist to use the drug in preference to slower onset/offset drugs. In the current environment of drug research, surveillance and licensing, it is debatable whether this drug would achieve the central place it still has in pediatric anesthesia. The arguments for and against its use are set out below by our two international experts, Marcin Rawicz from Poland and Barbara Brandom from USA. This will allow the reader an objective evaluation with which to make an informed choice about the use of suxamethonium in their practice.

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Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgia

Cited by 48 publications

References 9 publications

Pharmacological Interventions for Acceleration of the Onset Time of Rocuronium: A Meta-Analysis

Pharmacological Interventions for Acceleration of the Onset Time of Rocuronium: A Meta-Analysis

Succinylcholine or rocuronium? A meta-analysis of the effects on intubation conditions

The place of suxamethonium in pediatric anesthesia

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