title: Priming with rocuronium to accelerate the onset time of cisatracurium during intubation.
abstract: BACKGROUND
  The priming technique, in which a small dose of nondepolarizing muscle relaxant is administered 3-6 minutes before giving the intubation dose, can speed up the onset of muscle relaxation in patients with paralysis during intubation. We investigated the priming technique and compared 2 different priming agents (rocuronium and cisatracurium) at a priming time of 3 minutes and its effect on decreasing the onset time of cisatracurium.
  
  
  METHODS
  A total of 60 patients with ASA physical status I-II scheduled for elective surgery were enrolled. After induction with propofol and fentanyl, the patients were randomized into 1 of 3 groups. Group 1 received rocuronium 0.06 mg/kg as a priming dose. Group 2 received cisatracurium 0.01 mg/kg as a priming dose. Group 3 received normal saline and constituted the control group. After a 3-minute priming time, intubation doses of cisatracurium were given (Groups 1 and 2, 0.14 mg/kg; Group 3, 0.15 mg/kg). First twitch height percentage (T1/T0%; % of control) and train-of-four percentage (T4/T1%) were recorded every 10 seconds from baseline until T1/T0% reached 0.
  
  
  RESULTS
  Rocuronium (Group 1) and cisatracurium (Group 2) significantly accelerated the onset of cisatracurium (Group 1, 117.0 +/- 29.0 seconds; Group 2, 151.0 +/- 37.5 seconds; Group 3, 221.5 +/- 36.6 seconds; all p < 0.001).
  
  
  CONCLUSIONS
  Priming with rocuronium or cisatracurium for 3 minutes significantly accelerated the onset of cisatracurium. Priming with rocuronium for 3 minutes improved the onset time of cisatracurium even more than priming with cisatracurium itself.
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
authors.forename: Shih-Pin
authors.initials: SP
authors.lastname: Lin
authors.forename: Kuang-Yi
authors.initials: KY
authors.lastname: Chang
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Chen
authors.forename: Su-Man
authors.initials: SM
authors.lastname: Lin
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Chang
authors.forename: Kwok-Hon
authors.initials: KH
authors.lastname: Chan
authors.forename: Chien-Kun
authors.initials: CK
authors.lastname: Ting
mesh_terms: D000328:Adult; D000732:Androstanols / Q000494:pharmacology*; D001279:Atracurium / Q000031:analogs & derivatives* / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D011446:Prospective Studies; D000077123:Rocuronium; D013997:Time Factors
chemical_list: D000732:Androstanols; D009466:Neuromuscular Blocking Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; C101584:cisatracurium; D000077123:Rocuronium