Comparison of intubating conditions after rocuronium and suxamethonium following "rapid-sequence induction" with thiopentone in elective cases.
BACKGROUND
Rocuronium (Org 9426) was shown to have the fastest onset of action of all currently available non-depolarizing neuromuscular blocking drugs and to provide intubating conditions similar to those of suxamethonium 60 to 90 s after administration. We compared the intubating conditions after rocuronium and suxamethonium following rapid-sequence induction of anaesthesia.


METHODS
Fifty unpremedicated patients of ASA physical status I or II, scheduled for elective surgery were studied. Anaesthesia was induced with thiopentone 6 mg kg-1 followed randomly by suxamethonium 1 mg kg-1 or rocuronium 0.6 mg kg-1 and, 45 s later, intubation was commenced. Muscle fasciculations, intubating conditions and intubation time, haemodynamic variables and oxygenation were assessed.


RESULTS
Intubation time did not differ between suxamethonium (9.8 +/- 2.2 s) (mean +/- SD) and rocuronium (10.5 +/- 2.9 s), respectively. Intubating conditions were clinically acceptable (good or excellent) in all patients given suxamethonium and in 96% of the patients given rocuronium. However, the condition of the vocal cords was better (P < 0.05) and diaphragmatic response to intubation was less pronounced with suxamethonium (P < 0.05). Changes in heart rate and arterial blood pressure were similar in both groups.


CONCLUSIONS
The authors conclude that rocuronium is a suitable alternative to suxamethonium for rapid tracheal intubation even under unsupplemented thiopentone anaesthesia, at least in elective, otherwise healthy patients. Its use for rapid-sequence induction under emergency conditions, however, needs further investigation.
Sparr
H J
HJ
Department of Anaesthesia and Intensive Care Medicine, University of Innsbruck, Austria.
Luger
T J
TJ
Heidegger
T
T
Putensen-Himmer
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000732:Androstanols / Q000494:pharmacology*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000494:pharmacology*; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D000077123:Rocuronium; D013390:Succinylcholine / Q000494:pharmacology*; D013874:Thiopental / Q000494:pharmacology; D013997:Time Factors
D000732:Androstanols; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D013390:Succinylcholine; D013874:Thiopental; D000077123:Rocuronium