title: Dose of rocuronium for rapid tracheal intubation following remifentanil 2 μg kg-1 and propofol 2 mg kg-1.
abstract: BACKGROUND
  Full relaxation is not mandatory for successful tracheal intubation.
  
  
  OBJECTIVE
  We tried to find the dose of rocuronium that gave acceptable intubation conditions in a rapid sequence intubation with remifentanil and propofol.
  
  
  METHODS
  A dose-finding study of rocuronium using a modified Dixon's up-and-down method.
  
  
  METHODS
  A single tertiary care teaching hospital.
  
  
  METHODS
  Patients undergoing elective surgery under general anaesthesia.
  
  
  METHODS
  After premedication with midazolam and glycopyrrolate, anaesthesia was induced using remifentanil 2 μg kg and propofol 2 mg kg, and a predetermined dose of rocuronium was administered. The dose of rocuronium was determined by a modified Dixon's up-and-down method starting from 0.8 mg kg with an interval of 0.1 or 0.05 mg kg. Intubation was performed 60 s after the start of the rocuronium injection. Intubation conditions were graded as excellent, good or poor. Excellent or good were regarded as clinically acceptable.
  
  
  METHODS
  A dose of rocuronium needed for acceptable intubation condition in 50% of patients (ED50) during rapid tracheal intubation after induction of anaesthesia with remifentanil and propofol.
  
  
  RESULTS
  Twenty-eight patients were enrolled to obtain six crossovers. The ED50 of rocuronium was 0.20 mg kg (95% confidence interval, CI 0.17 to 0.23 mg kg) by a modified Dixon's up-and-down method.
  
  
  CONCLUSIONS
  After induction of anaesthesia with remifentanil 2 μg kg and propofol 2 mg kg, the ED50 of rocuronium for acceptable intubation condition was 0.20 mg kg (95% CI, 0.17 to 0.23 mg kg) for rapid sequence intubation. Thus, we recommend that the intubation dose should be 0.8 mg kg.
  
  
  BACKGROUND
  Clinical trial registration KCT0000094.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Ah-Young
authors.initials: AY
authors.lastname: Oh
authors.forename: Suk-Ju
authors.initials: SJ
authors.lastname: Cho
authors.forename: Kwang-Suk
authors.initials: KS
authors.lastname: Seo
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Ryu
authors.forename: Sung-Hee
authors.initials: SH
authors.lastname: Han
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Hwang
mesh_terms: D000293:Adolescent; D000328:Adult; D000732:Androstanols / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage*; D000077208:Remifentanil; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D000077208:Remifentanil; D000077123:Rocuronium; D015742:Propofol