title: Rocuronium versus succinylcholine for rapid-sequence induction using a variation of the timing principle.
abstract: OBJECTIVE
  To determine if, using a variation of the "timing" principle, 0.6 mg/kg of rocuronium can achieve an onset time and intubating conditions similar to those achieved with succinylcholine.
  
  
  METHODS
  Prospective, randomized, double-blind clinical comparison.
  
  
  METHODS
  Operating room in a university medical center.
  
  
  METHODS
  42 ASA physical status I and II patients undergoing general anesthesia for elective surgery.
  
  
  METHODS
  All patients were fitted with a Grass FT-10 force transducer attached to the thumb. Supramaximal stimulation was applied to the ulnar nerve with a variable current peripheral nerve stimulator. 22 patients (succinylcholine group) received a placebo bolus injection followed 20 seconds later by thiopental 4 to 5 mg/kg and succinylcholine 1 mg/kg; 20 additional patients (rocuronium group) received a bolus dose of rocuronium 0.6 mg/kg followed 20 seconds later by thiopental 4 to 5 mg/kg and a placebo bolus injection.
  
  
  RESULTS
  We measured the onset time from administration of the muscle relaxant to 95% twitch reduction and assessed the quality of intubating conditions 60 seconds after the induction of anesthesia. There was a significant difference in the mean onset time of rocuronium (72 sec) versus succinylcholine (42 sec, p < 0.0001). However, there was no significant difference in intubating conditions 60 seconds after administration of thiopental.
  
  
  CONCLUSIONS
  Rocuronium given 20 seconds prior to thiopental provides intubating conditions equivalent to thiopental-succinylcholine for rapid-sequence inductions, circumventing rocuronium's longer onset time to 95% neuromuscular blockade.
authors.affiliation: Department of Anesthesia, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1009, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Nelson
authors.forename: R C
authors.initials: RC
authors.lastname: Morell
authors.forename: J F
authors.initials: JF
authors.lastname: Butterworth
mesh_terms: D000732:Androstanols; D000758:Anesthesia; D004311:Double-Blind Method; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D010525:Peripheral Nerves / Q000187:drug effects / Q000502:physiology; D011446:Prospective Studies; D000077123:Rocuronium; D015398:Signal Transduction; D013390:Succinylcholine; D013997:Time Factors
chemical_list: D000732:Androstanols; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D013390:Succinylcholine; D000077123:Rocuronium