Abstract
BackgroundRapid sequence induction is a well-established anesthetic procedure used in patients with a high risk of gastric aspiration. Suxamethonium has been the drug of choice; however, it carries potential risks and sometimes fatal outcomes. The aim of our study was to compare rocuronium after pretreatment with dexmedetomidine, to suxamethonium in providing excellent intubating conditions in rapid sequence induction in adults. Patients were randomly allocated to one of two groups, of 120 each. Control group (SS), patients received pretreatment with 10 ml 0.9% saline over 10 min and suxamethonium 1mg/kg. Experimental group (DR), received pretreatment with dexmedetomidine 1 μg/kg in 10 ml 0.9% saline over 10 min and rocuronium 0.6 mg/kg. Our primary endpoint was the number of patients who scored “excellent” on intubation conditions score, while secondary outcomes were hemodynamics and adverse events.ResultsThe rate of excellent intubating conditions in the DR group 46% was insignificantly less (P value = 0.548) than that of the SS group 49% (relative risk (RR) of DR compared to SS = 1.04, with a confidence interval (CI) of 0.91–1.48. The percentage of patients with adverse events in the SS group was (30%) nearly more than twofold higher than that of the DR group (11%). A significant difference (P value = 0.016) in the incidence of excellent intubating conditions was higher in the female gender 59% compared to the male gender 38% (adjusted RR = 0.98, with a confidence interval of 0.79–1.1).ConclusionA combination of dexmedetomidine 1μg/kg and standard intubating dose of rocuronium 0.6 mg/kg provided comparable endotracheal intubation conditions to suxamethonium 1 mg/kg during RSI and might be used as an alternative to suxamethonium in situations where suxamethonium is contraindicated.Trial registrationClinicalTrials.gov Identifier: NCT04709315
Highlights
Rapid sequence induction is a well-established anesthetic procedure used in patients with a high risk of gastric aspiration
The ideal neuromuscular relaxant agent used for Rapid sequence induction (RSI) should have a quick onset, in addition to a short duration of action, which is a major advantage in a trauma setting, as it mitigates the risk of aspiration and desaturation when endotracheal intubation should be performed as early as possible
A total of 240 patients were randomized between saline + suxamethonium (SS) and dexmedetomidine + rocuronium (DR) groups of 120 patients each
Summary
Rapid sequence induction is a well-established anesthetic procedure used in patients with a high risk of gastric aspiration. The ideal neuromuscular relaxant agent used for RSI should have a quick onset, in addition to a short duration of action, which is a major advantage in a trauma setting, as it mitigates the risk of aspiration and desaturation when endotracheal intubation should be performed as early as possible. It should have a quick offset to ensure that if trials at endotracheal intubation were unsuccessful, there would be quick neuromuscular recovery, with a return to spontaneous breathing before the patient starts desaturation. Unfavorable intubation conditions that should be avoided include resisting the insertion of the laryngoscope, inability to visualize the cords, and patient reaction to the intubation and cuff inflation, e.g., coughing and diaphragmatic contraction (Morris & Cook, 2001)
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