Excellent Intubation Conditions Research Articles

Comparison of Intubating Conditions of Two Doses of Rocuronium Bromide with Succinylcholine in Children undergoing Elective Surgeries under General Anaesthesia- A Randomised Control Trial

Introduction: Succinylcholine is a muscle relaxant of choice for paediatric intubation due to its fast onset and ultrashort duration of action but it is associated with unwanted sideeffects. Rocuronium bromide can be used alternatively to avoid those unwanted side-effects because of its fast onset and intermediate duration of action. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations, and complications to get a better alternative dose of rocuronium bromide in children undergoing elective surgeries. Materials and Methods: The present randomised, doubleblinded clinical trial study was conducted in the Department of Anaesthesiology, Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India from January 2021 to October 2022. Ninety American Society of Anaesthesiology (ASA) Grade-I-II children of both sexes of 1-10 years age, undergoing elective surgery were equally divided into three groups. GroupR9 (n=30) and Group-R12 (n=30) received rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively while Group-S (n=30) received succinylcholine 1.5 mg/kg. Comparative evaluation of intubating conditions was done around 60 seconds in all three groups and duration of action, haemodynamic variations, and complications were noted. All data were entered in a microsoft excel sheet and results were expressed as percentages, mean Standard Deviation (SD), chi-square test, and Analysis of Variance (ANOVA) test where the difference was considered statistically significant if the p-value <0.05 by using the software Statistical Package for the Social Sciences version 11.0 (SPSS version 11.0). Results: Rocuronium bromide 1.2 mg/kg and succinylcholine 1.5 mg/kg provided excellent intubating conditions in 96.7% children and good intubating conditions in 3.3% children in both groups while rocuronium bromide 0.9 mg/kg provided excellent intubation conditions in 83.3% of children and good intubating conditions in 16.7% of children There was a significant difference present in intubation scores between three groups (p=0.01). The duration of action was longer with rocuronium bromide 1.2 mg/kg (38.93±4.323 min) as compared to rocuronium bromide 0.9 mg/kg (26.07±2.791 min) while it was shortest with succinylcholine 1.5 mg/kg (6.00±1.74 min). Adverse effects like fasciculations were only found in children (n=30) receiving succinylcholine (p=0.01) but not in rocuronium bromide groups. Conclusion: Rocuronium bromide 1.2 mg/kg gives the same intubating conditions as succinylcholine 1.5 mg/kg with good haemodynamic stability and no side-effects but the duration of action was longer with rocuronium bromide 1.2 mg/kg as compared to rocuronium bromide 0.9 mg/kg. So, to avoid unwanted sideeffects of succinylcholine in children, rocuronium bromide 1.2 mg/kg can be used as an alternative to succinylcholine 1.5 mg/ kg in children undergoing elective surgeries where early return of spontaneous recovery is not needed.

Comparison of different doses of atracurium for quality of muscle relaxation during modified rapid sequence induction in emergency laparotomy: A prospective randomised double blind study.

In emergency and non-fasting patients posted for laparotomy under general anaesthesia, rapid sequence induction (RSI) is preferred, and it is routinely done by using succinylcholine or rocuronium. Using higher doses of atracurium [i.e. 3-4 times the 95% effective dose (ED95)] can provide acceptable intubating conditions in a short time. The primary objective of our study was to compare two different higher doses of atracurium to achieve good intubating conditions for RSI without using a priming dose. The secondary objective was to compare the duration of muscle relaxation using neuromuscular monitoring and haemodynamic responses during and after intubation. Sixty patients were enroled and randomly assigned into two groups:-, group A1 (atracurium: 0.75 mg/kg) and group A2 (atracurium: 1 mg/kg). After premedication, anaesthesia was induced with propofol 2-2.5 mg/kg and atracurium injections, followed by intubation within a minute by trained anaesthesiologists. Meanwhile, intubating conditions, neuromuscular monitoring using train-of-four (TOF) measurements and post-tetanic-count and haemodynamics were recorded. Data were analysed statistically by using the Chi-square test and Student's t-test. Excellent intubation conditions (without coughing or bucking) were attained in 56.7% of cases in group A2 and in 13.3% in group A1 (P < 0.001). Duration of muscle relaxation, measured by time until TOF is two, was more prolonged in group A2 (79.2 ± 9.2 min) than in group A1 (60.13 ± 8.7 min, P < 0.001). Acceptable intubating conditions can be achieved in a minute with the use of a high dose of atracurium (1 mg/kg) during RSI. Hence, atracurium can be used as an alternative drug for RSI.

Comparison of rapid intubating conditions between rocuronium and cisatracurium

Background and aims Cisatracurium has many advantages over other nondepolarizing muscle relaxants; however, for rapid intubation, rocuronium is the preferred drug in lieu of succinylcholine. The aim of this study was to compare the onset time and intubating conditions at 90 s using 0.3 mg/kg cisatracurium (6× ED95) versus 1.2 mg/kg rocuronium (4× ED95). Material and methods The study was conducted at a tertiary care hospital as a randomized double-blind prospective study after obtaining the ethical committee clearance. A total of 60 patients were randomly assigned to receive 1.2 mg/kg rocuronium (4× ED95) or 0.3 mg/kg cisatracurium (6× ED95) after premedication with fentanyl-midazolam and induction with propofol-sevoflurane. Laryngoscopy and intubation were done at 90 s. Primary outcomes assessed were laryngoscopy and intubation conditions and onset times. The Student t test was used to compare prospective, repeated measures. χ 2 test was used to test the significance of difference for qualitative variables. Results The onset of action of the muscle relaxant was predicted by measuring train-of-four ratio and was found to be significantly longer in the cisatracurium group (149.50±25.064 s) than in the rocuronium group (101±s) (P&lt;0.05). Although the intubating conditions were better in the rocuronium group, cisatracurium also provided good to excellent intubation conditions at 90 s. Conclusion Cisatracurium can be used to intubate the trachea at 90 s at a dose of 0.3 mg/kg in patients premedicated with fentanyl-midazolam and induced with propofol-sevoflurane, while maintaining hemodynamic stability, without increasing the incidence of adverse effects.

Sample size considerations for studies comparing intubating conditions using quantitative monitoring versus a fixed interval during onset of neuromuscular blockade

IntroductionData in the literature are still scarce to establish any recommendations on the use of quantitative monitoring during tracheal intubation. Patients and methodsIn this monocentric study, non-morbidly obese adult female patients without risk factors for difficult tracheal intubation were prospectively included. After 0.5 mg.kg−1 atracurium during propofol-sufentanil anaesthesia, intubation conditions were evaluated using the Copenhague and Cormack-Lehane classification at the complete twitch suppression at the TOF to the AP (monitor group) or after a fixed 3 min waiting time after atracurium injection (3-min group). We also examined sample size for future studies. ResultsWe included 102 (monitor group) and 97 (3-min group) adult non-obese female patients without different characteristics. Intubation conditions were acceptable in 96/102 (94%) in the monitor group vs. 84/97 (87%) in the 3-min group, p = 0.07. The presence of a Cormack and Lehane view of 1 was marginally better in the monitor group as compared to the 3-min group, p = 0.041. We propose two possibility of sample size based on a difference of observed events based on acceptable intubation conditions, n = 602, or on excellent intubation conditions, n = 550. DiscussionThis observational study shows that the use of a neuromuscular TOF monitoring of the ulnar nerve as compared to a fixed 3-min waiting time after atracurium injection could improve laryngoscopic view and show a tendency to better intubation conditions without conclusive statistical significance. We suggest that researchers consider our recommendations in terms of the sample size to include in their future research, keeping in mind the limitations of our study.

Comparison of Hemodynamic Changes in Patients Undergoing Laparoscopic Cholecystectomy using rocuronium and vecuronium for Intubation and Maintenance under General Anesthesia.

Context:The context of the study is to compare and find better muscle relaxant between rocuronium and vecuronium for intubation and maintenance under general anesthesia in patients undergoing laparoscopic cholecystectomy.Aims:The aim of the study is to measure intubating condition, hemodynamic changes during intubation and also during maintenance of general anesthesia and to record complications, if any.Settings and Design:A prospective clinical study conducted in the Department of Anesthesiology in tertiary care center.Materials and Methods:A total of 100 patients of the American Society of Anesthesiologists Classes Grade I and II were planned for laparoscopic cholecystectomy were divided into two groups of 50 each. The subjects in the control and study group were put under anesthesia using injection propofol 2.0 mg.kg−1 along with injection vecuronium 0.10 mg.kg−1 and injection propofol 2.0 mg.kg−1 along with injection rocuronium 0.60 mg.kg−1, respectively. Hemodynamic monitoring and oxygen saturation (SPO2) were recorded at various intervals.Statistical Analysis Used:All the collected data were imported into Microsoft Excel, and the statistical analysis was done by using SPSS 25.0 version.Results:The mean heart rate before and after carboperitoneum at different time intervals and before and after extubation was significantly lower in vecuronium group. The mean systolic blood pressure and mean arterial pressure at 1 and 5 minutes after extubation were significantly more among vecuronium group.Conclusions:Rocuronium is reasonably cardiostable, produces excellent intubation conditions, has a shorter duration of action, and shows minimal cumulative effect.

Comparison of Rocuronium and Succinylcholine for Rapid Sequence Induction in patients undergoing surgery under General Anaesthesia

Objectives: To compare the frequency of excellent intubation condition with Succinylcholine and rocuronium for rapid sequence induction in patients undergoing surgery under general anesthesia.&#x0D; Design: Randomized control trial.&#x0D; Place and duration of study: Department of anesthesiology and pain medicine, Combined Military Hospital Malir Cantt Karachi from 25th June to 10th August 2019.&#x0D; Methodology: In this randomized control trial, a non-probability consecutive sampling technique was used. Anesthesia was given through a standard approach. Then patients were randomly divided into two equal groups. In group A, succinylcholine (1mg/Kg) was given while in group B, rocuronium (1mg/Kg) was given. Laryngoscopy was attempted after 60 seconds. Intubating conditions were labeled as excellent, good, poor, and impossible. All the data was collected in two groups, the data was entered and analyzed on SPSS version 21.&#x0D; Results: The mean age of the patients was 40.11±9.49 years. The male to female ratio of the patients was 0.7:1. The study results showed the excellent intubation conditions were noted in 11 from group A and 9 from group B, good intubation condition was noted in 29 from group A and 25 from group B, poor conditions were noted in 17 from group A and 16 from group B and the impossible intubation conditions were noted in 13 from group A and 20 from group B. Statistically insignificant difference was found between the study groups with intubation conditions i.e. p-value=0.570.&#x0D; Conclusion: It has been proved in our study that both the succinylcholine and rocuronium are statically equally effective in terms of excellent intubation conditions in the management of rapid sequence induction in patients undergoing surgery under general anesthesia.

ED50 of remifentanil for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of muscle relaxants in children: dose-finding clinical trial.

Previous studies evidenced that orotracheal intubation without neuromuscular blockers is feasible in children and has some potential advantages. Remifentanil has favorable pharmacodynamic and pharmacokinetic properties as an opioid for orotracheal intubation, but its dose for excellent intubation conditions when co-administered with propofol has not been established. This study was designed to find the minimum effective dose of remifentanil for excellent intubation conditions of children when co-administered with propofol, without neuromuscular relaxant drugs. Blinded adaptive clinical trial, with sequential allocation of 27 children between 2 and 9 years-old, American Society of Anesthesiologists' physical status PI or PII, scheduled for elective surgery under general anesthesia. Remifentanil dose began at 2µg/kg and varied by 0.25µg/kg according to the sequential allocation up-and-down rule designed by Dixon and Massey. Remifentanil was infused in 30s and followed by propofol (3mg/kg) in 20s. Laryngoscopy and intubation were performed and assessed using Viby-Mogensen criteria, 90s after the end of opioid administration. Inclusion of patients stopped after six crossovers, and remifentanil effective dose was estimated using pooled adjacent-violators algorithm. Remifentanil effective dose for 50% was established in 3.04µg/kg (IC 95% 2.68-3.11, p < 0.05). The most frequent adverse effect was difficult positive pressure facial mask ventilation, which occurred in four children (15%). Minimum remifentanil effective dose for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of neuromuscular blockers in children is 3.04µg/kg. NCT02454868.

Certain and controversial components of "rapid sequence induction"

Rapid sequence induction (RSI) is aspecific technique for anesthesia induction, which is performed in patients with an increased risk for pulmonary aspiration (e.g. intestinal obstruction, severe injuries and cesarean section). The incidence of acute respiratory distress syndrome (ARDS) is very low but 10-30% of anesthesia-related deaths are caused by the consequences of ARDS. The classical RSI with its main components (i.e. head-up position, avoidance of positive pressure ventilation and administration of succinylcholine) was published nearly 50years ago and has remained almost unchanged. The modified RSI consists of mask ventilation before endotracheal intubation is performed or the use of non-depolarizing muscle relaxants. Succinylcholine 1.0 mg/kg or rocuronium 1.0-1.2 mg/kg should be administered to achieve excellent intubation conditions. The use of cricoid pressure was acornerstone of RSI after its introduction in 1961; however, after controversial discussions in recent years, cricoid pressure has lost its importance. Before surgery gastric emptying with anasogastric tube is mandatory in patients with ileus and passage or defecation disorders.

Prospective, comparative, randomized, and controlled study of endotracheal intubation conditions without muscle relaxant in children receiving general anesthesia

Introduction Intubation without the need for a muscle relaxant is a common practice in pediatric patients. Many drugs are used; sevoflurane and propofol are used to improve the intubation score and to decrease the usage of a muscle relaxant and avoid its side effects. Aim This study aimed to compare intubation conditions and hemodynamic responses to two induction regimens, without a muscle relaxant using an anesthetic, sevoflurane versus propofol, in children, who required general anesthesia. Patients and methods A prospective controlled study was carried out on 90 patients with ASA physical status I and II scheduled for elective pediatric day case surgeries. Patients were divided into three equal groups of 30 patients each. The patients in the S group received inhalational induction sevoflurane. The P group received 3 mg/kg propofol intravenously. The C group received 2 mg/kg succinylcholine after 3 mg/kg propofol intravenously as a control group; maintenance was performed by inhalation using sevoflurane after intubation in all groups. The intubation conditions, hemodynamic parameters (heart rate, peripheral oxygen saturation) induction time, and recovery time were all recorded and statistically analyzed. Results With respect to the intubation conditions, no patient in any of the two groups (S and P groups) needed rescue a muscle relaxant for intubation. The S group showed more acceptable and excellent intubation conditions versus the propofol groups (100 and 96.7%, respectively). The heart rate was comparable in all groups at all readings; except during intubation, reading was highly significantly low in the sevoflurane group. Induction time was longer in the sevoflurane group than in the other groups. The recovery time was short in the S group than in the propofol group. Conclusion Endotracheal intubation without neuromuscular blocking agents in pediatric patients undergoing day case surgeries was achieved with no severe respiratory or hemodynamic adverse events by using propofol (3 mg/kg) or sevoflurane 8% at induction and then reduced to a maintenance level after intubation.

Dexmedetomidine Improves Intubating Conditions Without Muscle Relaxants in Children After Induction With Propofol and Remifentanil

(Abstracted from Anesth Analg, 121:785–790, 2015) Excellent intubation conditions reduce the risk of postoperative laryngeal injury in pediatric patients. Although administration of propofol (3 mg/kg) and remifentanil (2 μg/kg) without muscle relaxants can provide excellent conditions, there is risk of corresponding increases in bradycardia or hypotension.

Intraoperative hemodynamics with vecuronium bromide and rocuronium for maintenance under general anesthesia.

Aims:The present study is undertaken to compare the hemodynamic effects using vecuronium versus rocuronium for maintenance in patients undergoing general surgical procedures.Settings and Design:It is a prospective, randomized, and cohort study.Subjects and Methods:100 patients were randomly divided into two groups. All patients were induced with 5 mg/kg of thiopentone sodium, and intubation conditions were achieved with 1.5 mg/kg of suxamethonium, using a well-lubricated cuffed endotracheal tube of appropriate size. When the patient started to breathe spontaneously, they were administered either 0.6 mg/kg of rocuronium (Group A) or 0.1 mg/kg of vecuronium (Group B). Hemodynamic parameters (heart rate and mean arterial pressure [MAP]) were monitored before administering the drug; at 1, 5, 10, 15, and 20 min after the drug and at the end of the surgery.Statistical Analysis Used:Data were compiled, analyzed and presented as frequency, proportions, mean, standard deviation, percentages, and t-test using SPSS (version 16). A P < 0.05 was considered as significant.Results:The heart rate increased significantly at 1-min and 5-min after administration of rocuronium (83.76 ± 10.37 and 86.8 ± 9.98), unlike vecuronium. However, it gradually declined towards normal, and change in heart rate with either drug was not significant beyond 10 min. The MAP decreased significantly at 1-min after administration of rocuronium (96.68 ± 7.57) which later showed a gradual increasing trend when compared to vecuronium which had no statistically significant change at any time.Conclusions:For short surgical procedures rocuronium is a good alternative to vecuronium, as the drug is reasonably cardio stable, produces excellent intubation conditions, has a shorter duration of action, and shows minimal cumulative effect.

Ephedrine for shortening the time to achieve excellent intubation conditions during direct laryngoscopy in adults

Ephedrine for shortening the time to achieve excellent intubation conditions during direct laryngoscopy in adults

A systematic review and meta-regression analysis of mivacurium for tracheal intubation

We systematically reviewed factors associated with intubation conditions in randomised controlled trials of mivacurium, using random-effects meta-regression analysis. We included 29 studies of 1050 healthy participants. Four factors explained 72.9% of the variation in the probability of excellent intubation conditions: mivacurium dose, 24.4%; opioid use, 29.9%; time to intubation and age together, 18.6%. The odds ratio (95% CI) for excellent intubation was 3.14 (1.65-5.73) for doubling the mivacurium dose, 5.99 (2.14-15.18) for adding opioids to the intubation sequence, and 6.55 (6.01-7.74) for increasing the delay between mivacurium injection and airway insertion from 1 to 2 min in subjects aged 25 years and 2.17 (2.01-2.69) for subjects aged 70 years, p < 0.001 for all. We conclude that good conditions for tracheal intubation are more likely by delaying laryngoscopy after injecting a higher dose of mivacurium with an opioid, particularly in older people.

Safety of Propofol as an Induction Agent for Urgent Endotracheal Intubation in the Medical Intensive Care Unit

Propofol is known to provide excellent intubation conditions without the use of neuromuscular blocking agents. However, propofol has adverse effects that may limit its use in the critically ill patients, particularly in the hemodynamically unstable patient. We report on the safety and efficacy of propofol for use as an agent for urgent endotracheal intubation (UEI) in the critically ill patients. We reviewed the outcomes of 472 consecutive UEIs performed by a medical intensive care unit (ICU) team at a tertiary care hospital from November 2008 through November 2012. Outcome data were collected prospectively as part of an ongoing quality improvement project. Propofol was used as the sole sedative agent in 409 (87%) of the 472 patients. In 18 (4%) of the 472 patients, other agents (midazolam, lorazepam, or etomidate) were used in addition to propofol. Of the 472, 10 (2%) intubations were performed with a sedative agent other than propofol, and 35 (7%) of the 472 intubations were performed without any sedating agent. Endotracheal tube insertion was successful in all 472 patients. Complications of UEI in those patients who received propofol were as follows: desaturation (Sao 2 < 80%) 30 (7%) of the 427, hypotension (systolic blood pressure < 70 mm Hg) 19 (4%) of the 427, difficult intubation (>2 attempts) 44 (10%) of the 427, esophageal intubation 24 (6%) of the 427, aspiration 6 (1%) of the 427, and oropharyngeal injury 4 (1%) of the 427. There were no deaths. Average dose of propofol was 99 mg (standard deviation 7.39) per person. Our results compare favorably with the complication rate of UEI reported in the critical care and anesthesiology literature and indicate that propofol is a useful agent for airway management in the ICU.

Rocuronium For Tracheal Intubation In Patients Undergoing Emergency Surgery

Aims: To compare the intubating conditions between inj. Rocuronium and inj. Succinylcholine during rapid sequence intubation in patients posted for emergency surgeries. The primary outcome was excellent intubation conditions. The secondary outcome was acceptable conditions and complications associated with rocuronium. Methods and Material : 60 patients posted for emergency surgeries were randomly divided randomly in to two groups. Intubating conditions at 60 seconds were compared in group-A (inj.succinylcholine 1mg/kg) and group-B(inj. rocuronium 0.6mg/kg), 30 patients in each group. Intubating conditions were judged based on the scoring of ease of jaw opening, position of the vocal cords and degree of straining after tracheal intubation. Statistical analysis used: Data obtained were be analysed by t-test, chi-square test and fisher exact test wherever applicable. Results: Mean apnoea onset time was 28.37 sec in group-A whereas it was 41.13 seconds in group-B. The mean intubation score was 9.00 ± 00 in group-A and 8.43 ± 0.85 in group-B. No side effects were observed in both the groups. Conclusions: Rocuronium (o.6mg/kg) provided acceptable intubation conditions in most of the patients at 60 seconds but, unable to provide excellent intubating conditions in all of them during rapid sequence intubation. Suxamethonium is still the best muscle relaxant to accomplish intubation in emergent cases. If suxamethonium is contraindicated, Rocuronium may be used as an alternative.

Effect of ephedrine on intubating conditions created by propofol and rocuronium: a meta‐analysis

To evaluate the effect of ephedrine on intubation conditions (ICs) one minute after anesthesia induction using propofol and rocuronium. PubMed, EMbase, The Cochrane Library, ISI Web of Knowledge, Chinese Biomedical Literature Database, Google Scholar, and other databases were searched from inception to September 2012 to collect relevant randomized clinical trials (RCTs). We evaluated the risk of bias of the included studies by the Cochrane Collaboration's risk of bias tool and analyzed the data using RevMan 5.1. As the outcomes, excellent ICs, clinically acceptable ICs and side effects were evaluated with risk ratios (RRs). Five RCTs involving 396 patients were identified. The results of the meta-analysis demonstrated that ephedrine increased the rate of excellent ICs (RR = 2.40, 95% CI 1.89 to 3.05), but had no effects on the rate of clinically acceptable ICs (RR = 1.15, 95% CI 0.93 to 1.42) and the incidence of side effects (RR = 2.00, 95% CI 0.19 to 21.36). Besides, the results of subgroup analysis showed that both low dose and high dose of ephedrine increased the rate of excellent ICs, but only low dose increased the rate of clinically acceptable ICs. The results of sensitive analysis showed that both favored ephedrine (excellent ICs: RR = 2.54, 95% CI 1.69 to 3.83; clinically acceptable ICs: RR = 1.21, 95% CI 1.07 to 1.38). Ephedrine, without extra side effects, created superior ICs one minute after anesthesia induction using propofol and rocuronium, and low dose (i.e., 70-100 μg/kg) is recommended as the possible optimal dose.

Intubation time required for tracheal intubation with low-dose rocuronium in children with and without atropine

The purpose of this study was to determine the intubation time needed to facilitate tracheal intubation (Time(EI)) with a low dose of rocuronium (0.3 mg/kg) during propofol induction, and to determine whether this time was reduced by the administration of atropine. Forty-six children, aged 3-10 years, were randomly assigned to receive either saline (control group) or atropine 10 μg/kg (atropine group). Anesthesia was induced with alfentanil 10 μg/kg, propofol 2.5 mg/kg, and rocuronium 0.3 mg/kg. Each Time(EI) at which tracheal intubation was attempted was predetermined according to the up-and-down method. The values of Time(EI) that provided excellent intubation conditions in 50 and 95 % of patients were defined as Time(EI)50 and Time(EI)95, respectively. Time(EI)50 ± SD was 160 ± 26.2 and 150 ± 13.7 s in the control and atropine groups, respectively. Using isotonic regression, Time(EI)95 in the control and atropine groups was 199 s (95 % CI 198.8-200.7 s) and 171 s (95 % CI 171.3-172.1 s), respectively. Time(EI)95 was significantly higher in the control group than in the atropine group (P < 0.001). HR was significantly higher in the atropine group than in the control group during the study period. This study demonstrated that the Time(EI)95 of a low dose of rocuronium (0.3 mg/kg) required for excellent tracheal intubation was 199 s during i.v. anesthesia induction using propofol and alfentanil in children. Also, i.v. atropine (10 μg/kg) before anesthesia induction was able to reduce Time(EI)95 by 28 s.

Determination of optimal dose of succinylcholine to facilitate endotracheal intubation in pregnant females undergoing elective cesarean section

Aims: The study was carried out to find the optimal dose of succinylcholine for pregnant females, undergoing elective cesarean section under general anesthesia, in order to achieve excellent intubation conditions for a successful endotracheal intubation. Materials and Methods: One hundred and twenty pregnant females aged between 20 and 35 years were randomly allocated into 4 groups of 30 patients each. Group I received Inj. succinylcholine 0.5 mg/kg, Group II received 0.6 mg/kg, Group III received 1.0 mg/kg, and Group IV received 1.5 mg/kg intravenously. The response to ulnar nerve stimulation at the wrist was recorded using the peripheral nerve stimulator. Grading of intubation conditions was done 60 s after Inj. succinylcholine administration. Peak effect, peak time, and duration of absent respiratory movement (apnea time) was noted. Statistical Analysis: One-way analysis of variance (ANOVA) with post hoc analysis (Bonferroni test) has been applied to see significance among groups for continuous variables and the Chi-square test was performed for categoric variables. SPSS v 16 was used for statistical analysis for the study. Results: Peak effect achieved was similar with 0.6, 1.0, and 1.5 mg/kg. There was no statistically significant difference (P >0.05) in the time taken to achieve the peak effect (peak time) between 1.0 and 1.5 mg/kg. Apnea time was 242.7 ΁ 7.1 s with 1.0 mg/kg and 377.7 ΁ 28.9 s with 1.5 mg/kg (P Conclusion: The dose of 1.0 mg/kg of succinylcholine produces excellent intubation conditions in pregnant females similar to the conventional dose of 1.5 mg/kg and is associated with a significantly shorter duration of action.

Rocuronium for rapid sequence induction in morbidly obese patients

Rocuronium for rapid sequence induction in morbidly obese patients

Optimal remifentanil dosage for providing excellent intubating conditions when co‐administered with a single standard dose of propofol

This dose-response study aimed to determine the dose of remifentanil combined with propofol 2.5 mg.kg(-1) which provided excellent intubation conditions in 95% of patients. Ninety premedicated female ASA 1 and 2 patients were randomly allocated to five remifentanil dose groups (1, 2, 3, 4 or 5 microg.kg(-1)). Induction of anaesthesia was performed with a blinded dose of remifentanil infused over 60 s simultaneously co-administered with propofol 2.5 mg.kg(-1) infused over 45 s. Tracheal intubation was attempted 150 s after the beginning of induction. Intubating conditions were assessed with the Copenhagen score. A probit analysis was performed to calculate the intubating efficient doses (IED) of remifentanil in 95% of patients (IED(95)). Our data revealed that the IED(95) of remifentanil was 4.0 (95% CI: 3.4-5.6) microg.kg(-1), which was associated with a maximum decrease in heart rate and mean arterial pressure of < 30%, a finding which also applied to the other groups.