Comparative study between succinylcholine, rocuronium and magnesium sulphate with rocuronium in rapid sequence induction

Abstract

Background Rapid sequence induction usually applies when tracheal intubation must be performed in a patient who is suspected of having a full stomach and who is at risk of pulmonary aspiration of gastric contents. Succinylcholine is the traditional depolarizing neuromuscular-blocking agent used in rapid sequence induction. However, it has a number of undesirable side effects. Magnesium may have a role in potentiation of neuromuscular blockade produced by neuromuscular blockers such as rocuronium. Aim The aim of this study was to investigate the effects of magnesium sulphate pretreatment on intubating conditions and cardiovascular responses during rapid sequence tracheal intubation (RSI). Patients and methods A total of 60 adult patients were randomly allocated to three groups: the succinylcholine group, which received 1 mg/kg succinylcholine; the rocuronium group, which received 1.2 mg/kg rocuronium preceded 15 min with 500 ml normal saline; and the magnesium rocuronium group, which received 1.2 mg/kg rocuronium preceded 15 min with 60 mg/kg magnesium sulphate in 500 ml normal saline infusion. Anaesthesia was induced with fentanyl, propofol and a neuromuscular-blocking drug on the basis of the studied group. An anaesthesiologist, blinded to the rocuronium group assignments, performed RSI and assessed the onset time, intubating conditions and clinical duration of neuromuscular block in the different groups. Haemodynamics were recorded before magnesium sulphate or normal saline infusion, after anaesthesia induction and every minute after intubation for 5 min. Results The onset time was shortest in the succinylcholine and magnesium groups. The intubating conditions were significantly better in the magnesium group (P Conclusion Magnesium sulphate administered before RSI using fentanyl, propofol and rocuronium may shorten the onset time and improve the intubating conditions comparable to those of succinylcholine and suppress the haemodynamic stress response to intubation.