Title: A Comparative Study of Intubating Conditions and Cardiovascular Effects of Rocuronium and Succinylcholine in Rapid Sequence Induction and Intubation

Authors: Ibemhal Heisnam, K.Sarda Devi, S.Thoibahenba Singh, K. Upendra Singh, Rakesh Nongthombam

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i6.88

Abstract

Aim of Study: Succinylcholine is the most frequently used muscle relaxant for rapid sequence intubation but sometimes the need arises to use another agent. The aim of our study is to compare the haemodynamic profile and intubating conditions of rocuronium with that of succinylcholine during rapid sequence induction and intubation.

Material and Methods: 80 patients posted for emergency surgical procedure under general anaesthesia were randomly divided into two groups A & B. A rapid sequence induction and intubation were done in all the patients. Group a patients received 0.6mg/kg rocuronium and Group B received 1.5mg/kg succinylcholine. Intubation was done at 60 seconds after the administration of muscle relaxant and intubating conditions was graded according to Copenhagen Consensus Conference Rating Scale. The haemodynamic parameters (pulse rate& blood pressure) were recorded and compared.

Results: In both the groups pulse rate and blood pressure increases significantly just after intubation but the increase was not significant after 10 minutes. There was no significant difference regarding laryngoscopy, vocal cord relaxation and response to intubation in both the groups. Overall intubating conditions in group A and B were excellent in 77.5% and 82.5% while good in 20% and17.5% patients respectively. Only one patient (2.5%) in group A showed poor intubating condition. Clinically acceptable intubating conditions (excellent & good) were comparable in both the groups.

Conclusion: Rocuronium 0.6mg/kg provides clinically acceptable intubating conditions similar to succinylcholine 1.5mg/kg at 60 second during rapid sequence induction and intubation with minimum haemodynamic variations.

Key Words: Rocuronium, succinylcholine, intubating condition, rapid sequence intubation.

References

1.      Schneider RE, Caro DA. Neuromuscular blocking agents. In: Walls RM, ed. Manual of Emergency Medicine Airway. 2nd ed. Philadelphia, PA : Lippincott Williams & Wilkins :2004

2.      Martyn JAJ, Richtsfeld M. Succinylcholine induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anaesthesiology 2006; 104:158-159.

3.      Cooper RA and Crawford JS (1992). Comparison of intubating conditions after administration of Org 9246(rocuronium) and suxamethonum. British Journal of Anaesthesia 69, 269 – 273.

4.      Han TH, Martyn JA Onset and effectiveness of rucoronium for rapid onset of paralysis in patients with major burns priming or large bolus .Br.J. Anaesth. 2009; 102:55-60.

5.      Huizinga ACT, Vandenbrom RH, Wierda JM, Homnes FD, Hennis PJ. Intubating conditions and onset of Neuromuscular block of Rocuronium (ORG 9426): A comparison with suxamethonium. Acta Anaesthesiol Scand 1992 July;36(5): 463-68.

6.      Levy Th. Davis G.K, Duggan J, Szlam, F Determination of the haemodynamics and histamine release of rocuronium (Org 9426) when administered in increased dose under N2O/O2 – sufentanil anaesthesia – Anaesthesia Analgesia 1994;78:318 – 321.

7.      Shukla A, Dubey KP, Sharma MSN, Comparative evolution of Haemodynamics effects and intubating conditions after administration of Org 9426(Rocuronium) and Succinylcholic Indian J Anaesthesia 2004;48(6):476-79.

8.      Larsen PB, Hensen EG, Jacobsen LS, Wiis J, Holst P et al. Intubating conditions after Rocuronium or Succinylcholine for rapid sequence intubation with alfentanial and       propofol in the emergency patient. Eur J Anaesthesiology 2005 Oct; 22(10):748-53.

9.      Pery J, Lee J, and Wells G. Rocuronium versus succinylcholine for rapid sequence induction .Cochrane Database Sys Rev.2003 ;( 1): CD 002788.

10.  Ali A , Sheikh N A ,Khwaja S, Saleem J and Kaul SU. Comparision of Intubating conditions produced by Rcuronium and suxamethonium for Rapid Sequence Induction in Elective Caeseran.Annals Vol 14.No 1 Jan-Mar,2008:5-7.

11.  Rawle A .Seupaul, James H , Jones.  Does succinylcholine maximize intubating conditions better than rocuronium for rapid sequence intubation? Annals of Emergency Medicine.Volume57, No3: March 2011:301-302.

12.  Virendrakumar R Belekar ,Khamankar Rocuronium for Tracheal Intubation in patients undergoing emergency Surgery.IJPR Volume 3 Issue (2) 2013:18-

13.  Tran DTT, Newton EK, Mount VAH ,Lee JS, Wells GA, Perry JJ. Rocuronium versus succinylcholine for rapid sequence induction intubation (Review): Cochrane Database of systemic Review 2015, Issue 10 Art No: CD 002788.

14.  Syed Manzar Hassan, Sameer Ahmed A. Comparision between intubating conditions of succinylcholine and rocuronium bromide.  International Journal of Basic and Applied Medical Sciences, 2016 Vol.6(2) May-August pp.12-17.

15.  Lata D. Shetty Comparision of intubating conditions of succinylcholine with that of rocuronium.  CIB Tech Journal of Pharmaceutical Sciences 2014 Vol.3 July-September;23-27.

Corresponding Author

Dr Ibemhal Heisnam

Associate Professor, Department of Anaesthesiology and Critical Care

Jawaharlal Nehru Institute of Medical Sciences Imphal: - 795005 Manipur

Mobile no: 9856153557, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.