title: Rapid injection of rocuronium reduces withdrawal movement on injection.
abstract: OBJECTIVE
  To test whether rapid injection of rocuronium reduces withdrawal movement on injection.
  
  
  METHODS
  Randomized, prospective trial.
  
  
  METHODS
  Operating room in a university hospital.
  
  
  METHODS
  150 ASA physical status I and II patients aged 18 to 60 years, undergoing general anesthesia.
  
  
  METHODS
  Patients were randomized to three groups. After undergoing anesthesia induction with thiopental sodium, then 5 seconds later receiving a rubber tourniquet applied to the mid-forearm to stop intravenous (IV) flow by gravity, the pretreatment drug was injected. The tourniquet was held for 15 seconds then released, and 1.0 mg/kg of 1% rocuronium was injected IV. Group C patients (n = 50) were pretreated with 0.1 mL/kg of 0.9% NaCl and then injected with rocuronium slowly within 10 seconds. Group L patients (n = 50) were pretreated with 0.1 mL/kg of preservative-free 1% lidocaine and then injected with rocuronium slowly within 10 seconds. Group R patients (n = 50) were pretreated with 0.1 mL/kg of 0.9% NaCl and then rapidly injected with rocuronium within approximately one second (as quickly as possible).
  
  
  METHODS
  After injection of the patient with the study drug, a single anesthesiologist with no knowledge of the study protocol graded each patient's response as follows: 0 = no response; 1 = mild movement limited to the wrist only; 2 = moderate movement involving the elbow and shoulder; and 3 = severe movement involving more than one extremity.
  
  
  RESULTS
  Group C had the most intense and frequent withdrawal response. The frequency and intensity of withdrawal movement was significantly less in Groups L and R than Group C. No significant difference in withdrawal response between Groups L and R was noted.
  
  
  CONCLUSIONS
  Withdrawal response can be significantly reduced for rocuronium injection without lidocaine pretreatment, simply through rapid injection.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Keimyung University, School of Medicine, Joong-gu, Daegu 700-712, Korea. yclee@dsmc.or.kr
authors.forename: Yong Cheol
authors.initials: YC
authors.lastname: Lee
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Jang
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Kim
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000732:Androstanols / Q000008:administration & dosage* / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007275:Injections, Intravenous; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010146:Pain / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies; D000077123:Rocuronium; D012965:Sodium Chloride / Q000008:administration & dosage; D013874:Thiopental / Q000627:therapeutic use; D014111:Tourniquets; D055815:Young Adult
chemical_list: D000732:Androstanols; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D003473:Neuromuscular Nondepolarizing Agents; D012965:Sodium Chloride; D008012:Lidocaine; D013874:Thiopental; D000077123:Rocuronium