title: Tracheal intubation with rocuronium using the "timing principle".
abstract: We compared the endotracheal intubating conditions after rocuronium, using the "timing principle," with those after succinylcholine. The timing principle entails administration of a single bolus dose of nondepolarizing muscle relaxant, followed by an induction drug at the onset of clinical weakness. Forty-five patients were randomly assigned to three groups. Patients allocated to Groups 1 and 2 received rocuronium 0.6 mg/kg. At the onset of clinical weakness (onset of ptosis), anesthesia was induced with thiopental 4-6 mg/kg; intubation was accomplished after 45 s in Group 1 and after 60 s in Group 2. Patients in Group 3 received vecuronium (0.01 mg/kg) 3 min before the administration of thiopental and succinylcholine 1.5 mg/kg, and their tracheas were intubated 60 s later by a blind anesthesiologist. Intubating conditions were assessed according to a grading scale and were either good (5 patients in Groups 1 and 2, 4 patients in Group 3) or excellent (10 patients in Groups 1 + 2, 11 patients in Group 3) in all patients. Patients were interviewed postoperatively, and all were satisfied with the induction of anesthesia. We conclude that rocuronium 0.6 mg/kg provides good to excellent intubating conditions 45 and 60 s after the induction of anesthesia using the timing principle.
  
  
  CONCLUSIONS
  We compared the ease with which a breathing tube could be placed in patients using three techniques. The standard technique (succinylcholine) was compared with two others in which a muscle-relaxing drug (rocuronium) was administered just before the anesthetic drug (so-called timing principle). No difference among the techniques was observed.
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital Bern, Switzerland. tomsieber@compuserve.com
authors.forename: T J
authors.initials: TJ
authors.lastname: Sieber
authors.forename: A M
authors.initials: AM
authors.lastname: Zbinden
authors.forename: M
authors.initials: M
authors.lastname: Curatolo
authors.forename: G D
authors.initials: GD
authors.lastname: Shorten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000732:Androstanols; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D011015:Pneumonia, Aspiration / Q000209:etiology; D000077123:Rocuronium; D013997:Time Factors
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium