Abstract
ObjectiveThe present study aimed to evaluate the impact of 1.5 mg/kg succinylcholine or 1.2 mg/kg rocuronium, vs. 1.0 mg/kg succinylcholine on apnea duration in patients underwent rapid sequence induction (RSI).MethodsThis prospective cohort study was conducted in the Department of Anesthesiology in Shanghai General Hospital from July 2020 to November 2020. Apnea duration was defined as the time from apnea prompted by the PETCO2 waveform to the time the point of oxygen saturation declined to 90% (T90) and 95% (T95) after succinylcholine or rocuronium administration. The primary outcome included T90 and T95 changes in 1.5 mg/kg vs. 1.0 mg/kg succinylcholine groups and 1.5 mg/kg succinylcholine vs. 1.2 mg/kg rocuronium groups.ResultsA total of 265 participants were subjected for analysis. The succinylcholine (1.0 mg/kg) group had a significantly longer T90 (50.72, 95% confidence interval [CI, 7.60, 94.38], P = 0.015) and T95 (48.09, 95% CI [7.11, 89.07], P = 0.012) than the succinylcholine (1.5 mg/kg) group. In addition, significantly longer T90 (56.84, 95% CI [16.24, 97.44], P = 0.003) and T95 (50.57, 95% CI [12.58, 88.57], P = 0.003) were observed in the rocuronium (1.2 mg/kg) group than those in the succinylcholine (1.5 mg/kg) group. No severe side events were observed during the operation.ConclusionRocuronium and the lower dose of succinylcholine may be recommended to patients underwent RSI.
Highlights
Rapid sequence induction (RSI) is a special technique of anesthetic induction designed to reduce the risk of aspiration of secretions of any kind, e.g., regurgitated or vomited gastric contents
Apnea duration was defined as the time from apnea prompted by the PETCO2 waveform to the time the point of oxygen saturation declined to 90% (T90) and 95% (T95) after succinylcholine or rocuronium administration
The succinylcholine (1.0 mg/kg) group had a significantly longer T90 (50.72, 95% confidence interval [CI, 7.60, 94.38], P = 0.015) and to 95% (T95) (48.09, 95% CI [7.11, 89.07], P = 0.012) than the succinylcholine (1.5 mg/kg) group
Summary
Rapid sequence induction (RSI) is a special technique of anesthetic induction designed to reduce the risk of aspiration of secretions of any kind, e.g., regurgitated or vomited gastric contents. Succinylcholine is a short-acting depolarizing NMBA that is the most commonly conventionally used NMBA in RSI because of its fast onset and short duration [3]. The 1.0–1.2 mg/kg dose recommended for RSI has too long a duration of action that fatal hypoxia is imminent if the airway is difficult, especially if intubation and mask ventilation fail simultaneously. This disadvantage of rocuronium is not eliminated by the very rapid reversal with sugammadex [8], because this drug is often not available fast enough in emergency situations [9]. The selection of succinylcholine or rocuronium in RSI should be carefully considered and tailored to the specifics of each patient and their clinical indications and medical conditions
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