Comparison of muscular relaxation quality between the combination of remifentanil-atracurium and succinylcholine in rapid sequence induction and intubation

Abstract

Introduction: Rapid sequence induction and intubation is the method of choice for anesthesia induction in nonfasted, full stomach patients in the operating room. The aim of rapid sequence induction is to quickly secure the airway to reduce the risk of regurgitation and aspiration of gastric contents. Succinylcholine, which is the most commonly used neuromuscular blocker in rapid sequence induction, has several side effects. The aim of this study is to compare the effects of succinylcholine and atracurium on muscular relaxation quality in rapid sequence induction and intubation. Materials and Methods: In this blinded, controlled clinical trial, seventy patients undergoing elective herniorrhaphy or orthopedic limb surgery randomly received one of the drug combinations, fentanyl/remifentanil/atracurium/nesdonal or fentanyl/nesdonal/succinylcholine and were evaluated for relaxation of the jaw muscles, vocal cord condition, and muscular response to intubation. Results: There was no significant difference in jaw relaxation, vocal cord condition, and muscular response to intubation between groups. Mean systolic and diastolic blood pressure and pulse rate were significantly lower in remifentanil-atracurium group compared to the succinylcholine group. Conclusion: Keeping the side effects of succinylcholine in mind, it seems that using remifentanil-atracurium combination for rapid sequence induction and intubation of the trachea produces results comparable to succinylcholine and consequently can be used as an alternative approach.