Are intubation conditions using rocuronium equivalent to those using succinylcholine?
OBJECTIVE
To determine whether the intubation conditions created by rocuronium are equivalent to those of succinylcholine during rapid-sequence induction (RSI).


METHODS
Medline, EMBASE, and the Cochrane Controlled Trials Register were searched for randomized clinical trials (RCTs). The search strategy included all generic and trade names for succinylcholine and rocuronium, anesthesia, neuromuscular blockade, and a validated RCT filter. Intubation conditions were a required outcome. Two reviewers assessed studies for eligibility, data extraction, and quality. Intubation conditions were scored with Goldberg's scale (excellent conditions defined as clear vocal cords, easy tube insertion, and no cough). A-priori subgroup analysis was conducted for the sedative, use of opioids, true versus modified RSI, age group, and the dose of rocuronium. Data were analyzed with Metaview 4.1 for relative risk (RR) of achieving excellent intubation conditions. A sample size calculation determined that n = 468 is required for equivalence.


RESULTS
Forty articles were identified; ten articles were excluded by the inclusion criteria, two were duplicate publications, and two had insufficient data. Therefore, 26 studies were analyzed. Overall, rocuronium was inferior to succinylcholine, with a RR = 0.87 (95% CI = 0.81 to 0.94) (N = 1,606). However, intubation conditions were similar in the propofol subgroup, with a RR = 0.96 (95% CI = 0.87 to 1.06) (N = 640). Failed intubations (N = 28) were equivalent in the two groups.


CONCLUSIONS
Overall, succinylcholine creates excellent intubation conditions more reliably than rocuronium. If a second-line agent is required, rocuronium used with propofol creates intubation conditions equivalent to those with succinylcholine.
Perry
Jeffrey Joseph
JJ
Division of Emergency Medicine, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada. jperry@ohri.ca
Lee
Jacques
J
Wells
George
G
D000328:Adult; D000368:Aged; D000732:Androstanols; D000770:Anesthesia, Endotracheal; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents; D016032:Randomized Controlled Trials as Topic; D000077123:Rocuronium; D013390:Succinylcholine
D000732:Androstanols; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D000077123:Rocuronium