Intubation conditions after rocuronium or succinylcholine for rapid sequence induction with alfentanil and propofol in the emergency patient.
OBJECTIVE
Previous studies mainly conducted on elective patients recommend doses of 0.9-1.2 mg kg[-1] rocuronium to obtain comparable intubation conditions with succinylcholine 1.0 mg kg[-1] after 60 s during a rapid-sequence induction. We decided to compare the overall intubating conditions of standard doses of rocuronium 0.6 mg kg[-1] and succinylcholine 1.0 mg kg[-1] during a strict rapid-sequence induction regimen including propofol and alfentanil.


METHODS
Male and female patients (ASA I-III) older than 17 yr scheduled for emergency abdominal or gynaecological surgery and with increased risk of pulmonary aspiration of gastric content were randomized to a rapid-sequence induction with succinylcholine 1.0 mg kg[-1] or rocuronium 0.6 mg kg[-1]. Patients with a predicted difficult airway were excluded. A senior anaesthesiologist 'blinded' for the randomization performed the intubation 60 s after injection of the neuromuscular blocker. Intubating conditions were evaluated according to an established guideline. Tracheal intubation not completed within 30 s was recorded as failed.


RESULTS
222 patients were randomized. Three patients had their operation cancelled and 10 did not fulfil the inclusion criteria. Clinically acceptable intubation conditions were present in 93.5% and 96.1% of patients in the succinylcholine group (n=107) and the rocuronium group (n=102), respectively (P=0.59).


CONCLUSIONS
During a rapid-sequence induction with alfentanil and propofol, both rocuronium 0.6 mg kg[-1] and succinylcholine 1.0 mg kg[-1] provide clinically acceptable intubation conditions in 60 s in patients scheduled for emergency surgery. Under the conditions of this rapid-sequence induction regimen rocuronium may be a substitute for succinylcholine.
Larsen
P B
PB
University of Copenhagen, Department of Anaesthesiology, Herlev Hospital, Glostrup, Denmark. pebola01@herlevhosp.kbhamt.dk
Hansen
E G
EG
Jacobsen
L S
LS
Wiis
J
J
Holst
P
P
Rottensten
H
H
Siddiqui
R
R
Wittrup
H
H
Sørensen
A M
AM
Persson
S
S
Engbaek
J
J
D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015760:Alfentanil; D000732:Androstanols; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004632:Emergency Medical Services; D005260:Female; D013509:Gynecologic Surgical Procedures; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D011015:Pneumonia, Aspiration; D015742:Propofol; D012306:Risk; D000077123:Rocuronium; D013390:Succinylcholine
D000732:Androstanols; D018686:Anesthetics, Intravenous; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D015760:Alfentanil; D013390:Succinylcholine; D000077123:Rocuronium; D015742:Propofol