Thiopental or etomidate for rapid sequence induction with rocuronium

Abstract

We have assessed the effect of the choice of i.v. induction agent on intubation conditions, 60 s after administration of rocuronium 0.6 mg kg-1. We studied 60 adult patients, allocated randomly to one of two groups. Anaesthesia was induced with alfentanil 10 micrograms kg-1 followed by thiopental 5 mg kg-1 (AT-R group; n = 30) or etomidate 0.3 mg kg-1 (AE-R group; n = 30). Both groups received rocuronium 0.6 mg kg-1. Laryngoscopy was started 60 s later and intubation conditions were evaluated according to a standard score, which considered ease of laryngoscopy, condition of the vocal cords and reaction to intubation. In the AT-R group, overall intubation conditions were scored as excellent in 20 patients, good in nine and fair in the remaining patient. In the AE-R group, overall intubating conditions were excellent in 24 and good in six patients. The difference between the two groups was not significant. Of the three components of the intubation score assessed, response to intubation stimulus was significantly less pronounced in group AE-R compared with group AT-R (P < 0.05): group AE-R, no reaction in 24 patients, slight diaphragmatic movement in five and mild coughing in one patient; group AT-R, no reaction in 13, slight diaphragmatic movement in 14, mild coughing in two and severe coughing in one patient. We conclude that etomidate as part of an induction regimen containing alfentanil and rocuronium attenuated the reaction to intubation to a greater extent than thiopental.

Influência do propofol e do etomidato no bloqueio neuromuscular produzido pelo rocurônio: avaliação pela aceleromiografia

“…Studies about the influence of hypnotics in neuromuscular blockers onset performed with vecuronium have shown a faster onset with etomidate as compared to thiopental and propofol, which could be attributed to the better hemodynamic profile of etomidate 6 . As to rocuronium, similar results were observed with etomidate and thiopental; however, there has been less diaphragmatic reaction in the etomidate group 20 . In our study, cough and diaphragmatic movement after tracheal intubation were observed with both drugs.…”

“…A maioria dos autores correlaciona a influência dos agentes hipnóticos na latência do bloqueio neuromuscular com a estabilidade hemodinâmica e, indiretamente, com o grau de perfusão muscular. O agente hipnótico escolhido para a indução anestésica influencia nas condições de intubação traqueal de várias maneiras: por depressão de reflexos larínge-os e faríngeos aos estímulos da intubação traqueal e também por potencializarem os efeitos de alguns bloqueadores neuromusculares [19][20][21] . Dentre os agentes hipnóticos o propofol é amplamente empregado para a indução de anestesias, por deprimir de maneira significativa os reflexos laríngeos e faríngeos, podendo até mesmo prescindir da ação complementar dos BNM não despolarizantes para a intubação traqueal.…”

“…Esse efeito evidencia a superioridade do propofol em relação a outros hipnóticos, exteriorizada pela maior incidência de imobilidade das cordas vocais, vista até mesmo nos ensaios nos quais os BNM não despolarizantes não foram utilizados . Em relação ao rocurô-nio, resultados semelhantes foram observados com o etomidato e tiopental; no entanto, houve menor incidência de reação diafragmática nos pacientes do grupo do etomidato 20 .…”

“…Most authors correlate the influence of hypnotic agents on neuromuscular block onset to hemodynamic stability and, indirectly, to the degree of muscle perfusion. The hypnotic used for anesthetic induction influences tracheal intubation conditions in different ways: by decreasing laryngeal and pharyngeal reflexes to tracheal intubation stimulations and also by potentiating the effects of some neuromuscular blockers [19][20][21] . Propofol is widely used to induce anesthesia for significantly depressing laryngeal and pharyngeal reflexes, sometimes doing without non-depolarizing NMBs for tracheal intubation.…”

The Effects of a Subhypnotic Dose of Ketamine on Neuromuscular Block Characteristics of Rocuronium and Intubation Quality

“…24 The induction agents such as etomidate and ketamine are known to improve intubation conditions by maintaining cardiac output and blood pressure and accelerating the onset time of rocuronium. 11,21,25 Although our study is in accordance with these studies as Group K has had higher heart rates and shorter onset times than those of Group S, we could not demonstrate better intubation quality scores in Group K. We related this situation to the relatively smaller dose of ketamine used in our study.…”