The effects of nicardipine or esmolol on the onset time of rocuronium and intubation conditions during rapid sequence induction: a randomized double-blind trial.
OBJECTIVE
The main aims of rapid sequence induction (RSI) are prompt and adequate muscle relaxation for tracheal intubation and hemodynamic stability during and after intubation. The purpose of the present study was to investigate the effects of nicardipine and esmolol on the action of rocuronium and intubation conditions during RSI.


METHODS
Adult patients (n = 82) were randomly allocated to one of three groups. One minute prior to the induction of sevoflurane-based general anesthesia, patients received 20 μg/kg of nicardipine (N group; n = 27) or 0.5 mg/kg of esmolol (E group; n = 27), or 5 ml of saline (C group; n = 28). Patients were assessed according to intubation conditions, the onset time of rocuronium, mean arterial pressure (MAP), and heart rate (HR) during RSI.


RESULTS
The intubation conditions and score were significantly better in the C and N groups than in the E group (P < 0.001). The onset time of rocuronium was shortened in the N group and prolonged in the E group when compared to the C group (P < 0.001). A significant attenuation in the increase of MAP immediately after intubation was observed in the N group as compared with the C and E groups (P < 0.008). HR was significantly lower in the E group than in the N and C groups (P < 0.01).


CONCLUSIONS
Pretreatment with nicardipine for RSI improved intubation conditions and shortened the onset time of rocuronium and attenuated changes in MAP after intubation. Esmolol may disturb intubation conditions and the onset of action of rocuronium, despite being effective in alleviating responses of HR after RSI.
Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, 215-4, Gongneug-dong, Nowon-gu, Seoul, 139-706, Republic of Korea. Jiheui0255@daum.net.
Ji Heui
JH
Lee
Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, 215-4, Gongneug-dong, Nowon-gu, Seoul, 139-706, Republic of Korea.
Yunkwang
Y
Kim
Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, 215-4, Gongneug-dong, Nowon-gu, Seoul, 139-706, Republic of Korea.
Kye Hyeok
KH
Lee
Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, 215-4, Gongneug-dong, Nowon-gu, Seoul, 139-706, Republic of Korea.
Sung Kyu
SK
Rim
Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, 215-4, Gongneug-dong, Nowon-gu, Seoul, 139-706, Republic of Korea.
Ji Yeon
JY
Lee
Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, 215-4, Gongneug-dong, Nowon-gu, Seoul, 139-706, Republic of Korea.
Cheong
C
Lee
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000328:Adult; D000732:Androstanols / Q000008:administration & dosage*; D000768:Anesthesia, General / Q000379:methods; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D009529:Nicardipine / Q000494:pharmacology*; D011412:Propanolamines / Q000494:pharmacology*; D000077123:Rocuronium; D000077149:Sevoflurane
D000319:Adrenergic beta-Antagonists; D000732:Androstanols; D008738:Methyl Ethers; D011412:Propanolamines; D000077149:Sevoflurane; D009529:Nicardipine; C036604:esmolol; D000077123:Rocuronium