Tracheal intubation with rocuronium bromide using the ‘timing principle’ – a comparison with succinylcholine for rapid sequence induction

Abstract

Background: Rapid sequence induction and intubation aims to secure the airway at the earliest possible time to protect the airway. Succinylcholine is the most popular drug for this but rocuronium is an alternative when succinyl choline is contraindicated. Aim: We aimed to compare intubating conditions following intravenous rocuronium bromide (0.6 mg/kg and 1.0 mg/kg) using the ‘timing principle’ with that following intravenous succinylcholine hydrochloride (2 mg/kg). Methods: Sixty patients, ASA I or II, undergoing elective surgery were randomly assigned to one of three groups: Roc 0.6 (n=20) and Roc 1.0 groups (n=20) received rocuronium 0.6 mg/kg and 1.0 mg/kg respectively and anaesthesia induced at the onset of clinical weakness with thiopentone 5 mg/kg. Sch 2.0 group received thiopentone 5 mg/kg followed by succinylcholine hydrochloride 2.0 mg/kg. Intubating conditions were assessed 60 seconds after administration of thiopentone and were graded as excellent, good or poor. Results: Excellent intubating conditions were obtained in 70% of patients in Roc 0.6 and Sch 2.0 groups, and in 55% of patients in Roc 1.0 group. Conclusion: Rocuronium bromide administered in a dose of 0.6 mg/kg using the timing principle seems to be a suitable alternative to succinylcholine when a rapid onset of neuromuscular blockade is desired.