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Intubation conditions after rocuronium or succinylcholine for rapid sequence induction with alfentanil and propofol in the emergency patient

Published online by Cambridge University Press:  15 September 2005

P. B. Larsen ,
E. G. Hansen ,
L. S. Jacobsen ,
J. Wiis ,
P. Holst ,
H. Rottensten ,
R. Siddiqui ,
H. Wittrup ,
A. M. Sørensen  and
S. Persson
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P. B. Larsen
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark
E. G. Hansen
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark
L. S. Jacobsen
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Glostrup Hospital, Glostrup, Denmark
J. Wiis
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark
P. Holst
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Glostrup Hospital, Glostrup, Denmark
H. Rottensten
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark
R. Siddiqui
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Glostrup Hospital, Glostrup, Denmark
H. Wittrup
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark
A. M. Sørensen
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark
S. Persson
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Glostrup Hospital, Glostrup, Denmark
J. Engbæk
Affiliation:
University of Copenhagen, Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark
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Summary

Background and objective: Previous studies mainly conducted on elective patients recommend doses of 0.9–1.2 mg kg−1 rocuronium to obtain comparable intubation conditions with succinylcholine 1.0 mg kg−1 after 60 s during a rapid-sequence induction. We decided to compare the overall intubating conditions of standard doses of rocuronium 0.6 mg kg−1 and succinylcholine 1.0 mg kg−1 during a strict rapid-sequence induction regimen including propofol and alfentanil. Methods: Male and female patients (ASA I–III) older than 17 yr scheduled for emergency abdominal or gynaecological surgery and with increased risk of pulmonary aspiration of gastric content were randomized to a rapid-sequence induction with succinylcholine 1.0 mg kg−1 or rocuronium 0.6 mg kg−1. Patients with a predicted difficult airway were excluded. A senior anaesthesiologist ‘blinded’ for the randomization performed the intubation 60 s after injection of the neuromuscular blocker. Intubating conditions were evaluated according to an established guideline. Tracheal intubation not completed within 30 s was recorded as failed. Results: 222 patients were randomized. Three patients had their operation cancelled and 10 did not fulfil the inclusion criteria. Clinically acceptable intubation conditions were present in 93.5% and 96.1% of patients in the succinylcholine group (n = 107) and the rocuronium group (n = 102), respectively (P = 0.59). Conclusions: During a rapid-sequence induction with alfentanil and propofol, both rocuronium 0.6 mg kg−1 and succinylcholine 1.0 mg kg−1 provide clinically acceptable intubation conditions in 60 s in patients scheduled for emergency surgery. Under the conditions of this rapid-sequence induction regimen rocuronium may be a substitute for succinylcholine.

Keywords

ANAESTHESIA GENERALINTUBATION INTRATRACHEAL, rapid-sequence inductionNEUROMUSCULAR BLOCKING AGENTS, succinylcholine, rocuronium
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 10 , October 2005 , pp. 748 - 753
Copyright
© 2005 European Society of Anaesthesiology

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