Comparison of suxamethonium and priming with atracurium for rapid sequence orotracheal intubation in a Nigerian adult population.
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.
Yusuf
A H
AH
Department of Anaesthesia, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria.
Okeke
C I
CI
Merah
N A
NA
Olatosi
J O
JO
Desalu
I S
IS
Kushimo
O T
OT
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
D009467:Neuromuscular Depolarizing Agents; D001279:Atracurium; D013390:Succinylcholine