title: Comparison of suxamethonium and priming with atracurium for rapid sequence orotracheal intubation in a Nigerian adult population.
abstract: OBJECTIVE
  To compare suxamethonium with atracurium using the priming principle, for rapid sequence orotracheal intubation assessing onset time, time to successful laryngoscopy and intubation and quality of intubating conditions.
  
  
  METHODS
  A prospective double-blind, randomised study was performed in 90 ASA physical status I and II patients aged between 18 and 64 years undergoing elective surgery requiring endotracheal intubation between October 2002 and June 2003 in a university teaching hospital . All patients were premedicated with 5-10mg oral diazepam and randomly assigned to one of two groups to receive either suxamethonium as a bolus dose (group A) or atracurium (priming with 0.05 mg/kg followed by 0.55 mg/kg after induction of anaesthesia) (group B). In both groups, the trachea was intubated when there was maximal muscle relaxation, determined clinically by jaw muscle relaxation. Muscle paralysis using a PNS, quality of intubating conditions, and occurrence of muscle weakness due to the priming dose of atracurium, time to laryngoscopy and onset time were all noted.
  
  
  RESULTS
  Onset time was 87.1 +/- 25.60s and 135.8 +/- 46.23s in groups A and B respectively (P < 0.05). Group A had a laryngoscopy time of 73.6 +/- 25.22s compared to 107.7 +/- 41.32s in group B (P < 0.05). Intubating conditions were significantly better in group A compared to group B (P < 0.05). The frequency of muscle weakness from the priming dose of atracurium was 6.6%.
  
  
  CONCLUSIONS
  Atracurium, using the priming principle, is an option in our environment for modified rapid sequence induction when suxamethonium is contraindicated.
authors.affiliation: Department of Anaesthesia, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria.
authors.forename: A H
authors.initials: AH
authors.lastname: Yusuf
authors.forename: C I
authors.initials: CI
authors.lastname: Okeke
authors.forename: N A
authors.initials: NA
authors.lastname: Merah
authors.forename: J O
authors.initials: JO
authors.lastname: Olatosi
authors.forename: I S
authors.initials: IS
authors.lastname: Desalu
authors.forename: O T
authors.initials: OT
authors.lastname: Kushimo
mesh_terms: D000328:Adult; D001279:Atracurium; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents; D009549:Nigeria; D011446:Prospective Studies; D013390:Succinylcholine
chemical_list: D009467:Neuromuscular Depolarizing Agents; D001279:Atracurium; D013390:Succinylcholine