Prehospital tracheal intubating conditions during rapid sequence intubation: rocuronium versus vecuronium.
BACKGROUND
The study purpose was to evaluate tracheal intubating conditions and cardiovascular effects of rocuronium (roc) and vecuronium (vec) in the transport setting.


METHODS
A prospective blinded study of adult patients requiring emergency rapid sequence oral tracheal intubation using direct laryngoscopy. Patients received equipotent doses of roc 1.0 mg/kg (n = 44) or vec 0.15 mg/kg (n = 56) on an alternate day basis.


RESULTS
Intubation was successful in 95% of patients in the vec group and 100% in the roc group. The percentage of patients having good or excellent jaw relaxation and vocal cord exposure was similar between groups (vec/79%, roc/77%). Eleven patients (vec/7, roc/4) had difficult intubation as evidenced by Grade III or IV view and more than three attempts. Five patients in the vec group had inadequate neuromuscular blockade versus 1 patient in the roc group (P = 0.17). No cardiovascular differences occurred between groups after intubation.


CONCLUSIONS
Tracheal intubating conditions and clinical evidence of complete neuromuscular blockade tended to be better after roc than after vec.
Smith
Charles E
CE
MetroHealth Medical Center, Department of Anesthesiology, Cleveland, OH 44109, USA. csmith@metro-health.org
Kovach
Betty
B
Polk
James D
JD
Hagen
Joan F
JF
Fallon
William F
WF
D000328:Adult; D000732:Androstanols / Q000008:administration & dosage* / Q000494:pharmacology; D004632:Emergency Medical Services; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage* / Q000494:pharmacology; D009820:Ohio; D011446:Prospective Studies; D000077123:Rocuronium; D014187:Transportation of Patients; D014673:Vecuronium Bromide / Q000008:administration & dosage* / Q000494:pharmacology
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D000077123:Rocuronium