Rapid Tracheal Intubation Research Articles

Current practice of Rapid sequence induction of anesthesia; A systematic review

Background: Pulmonary aspiration can cause mortality and morbidity due to the entrance of gastric content into the respiratory tract. Rapid sequence induction (RSI) is a technique adopted for the avoidance of regurgitation, or aspiration while performing rapid tracheal intubation on patients during general anesthesia induction. This intervention includes several steps; nonetheless, RSI practice varies greatly. Aim: To identify the practice of rapid sequence induction of anesthesia performed by anesthetists. Methods: Obtaining related articles for this review depended on searching through scientific databases using related terms. Among all the obtained articles and studies, original articles written in the English language with quantitative analysis and available for full-text were considered eligible and included. Results: Seven studies met the criteria and were enrolled; two studies reported practicing RSI among pediatrics, one study involved pediatric and adult populations, two studies reported practicing RSI among adults and the remaining two studies didn't specify the population. Three studies compared the practice between consultant anesthetists and trainees. One study focused on the adherence to RSI practice. Conclusion: The practice of rapid sequence induction exhibited wide variations between different nations, age groups of patients, anesthetists‘ experience, and positions.

Determining an optimum propofol infusion rate for induction of anaesthesia in healthy dogs: a randomized clinical trial

ObjectiveTo determine an optimum infusion rate of propofol that permitted rapid tracheal intubation while minimizing the duration of postinduction apnoea. Study designProspective, randomized, blinded clinical trial. AnimalsA total of 60 client-owned dogs presented for elective neutering and radiography. MethodsDogs were randomly allocated to one of five groups (groups A–E) to have propofol at an infusion rate of 0.5, 1, 2, 3, or 4 mg kg–1 minute–1, respectively, following intramuscular premedication with methadone 0.5 mg kg–1 and dexmedetomidine 5 μg kg–1. Propofol administration was stopped when adequate conditions for tracheal intubation were identified. Time to tracheal intubation and duration of apnoea were recorded. If oxygen haemoglobin saturation decreased to < 90%, manual ventilation was initiated. A one-way analysis of covariance was conducted to compare the effect of propofol infusion rate on duration of apnoea and intubation time whilst controlling for covariates, followed by post hoc tests. The significance level was set at p < 0.05. ResultsPropofol infusion rate had a significant effect on duration of apnoea (p = 0.004) and intubation time (p < 0.001) after controlling for bodyweight and sedation scores, respectively. The adjusted means (± standard error) of duration of apnoea were significantly shorter in groups A and B (49 ± 39 and 67 ± 37 seconds, respectively) than in groups C, D and E (207 ± 34, 192 ± 36 and 196 ± 34 seconds, respectively). Group B (115 ± 10 seconds) had a significantly shorter intubation time than group A (201 ± 10 seconds, p < 0.001). Conclusions and clinical relevanceAn infusion rate of 1.0 mg kg–1 minute–1 (group B) appears to offer the optimal compromise between speed of induction and duration of postinduction apnoea.

The effect of low-dose rocuronium on rapid tracheal intubation using a video laryngoscope: A randomized double blind controlled study.

Background:The aim of this study was to investigate the clinical effectiveness of rocuronium in low doses on conditions during rapid tracheal intubation using video laryngoscope.Methods:Ninety-eight patients undergoing otolaryngologic surgery were randomly divided into 2 groups: group L using 0.3 mg/kg of rocuronium intravenously (n = 49) and group C using 0.6 mg/kg of rocuronium (n = 49). Sixty seconds after rocuronium administration, tracheal intubation was performed using a video laryngoscope. The overall intubation condition was evaluated along with specific conditions, including laryngoscopy condition, vocal cord position, and intubation response. Intubation profiles, including Cormack–Lehane grade, 1st attempt success rate, and intubation time, were also evaluated.Results:Overall intubation conditions showed a significant difference between group L and group C (P = .003). Although the incidence of vigorous response after tracheal intubation was higher in group L than in group C (P = .022), laryngoscopy condition and vocal cord position were similar between the 2 groups (P = .145 and .070, respectively). Intubation profiles showed no differences between the 2 groups. The frequency and amount of additional rocuronium administration during surgery were also similar.Conclusions:Low-dose rocuronium provided significantly worse overall intubation conditions compared to the conventional dose of rocuronium for rapid tracheal intubation. However, when using a video laryngoscope, it may provide clinically acceptable laryngeal muscle relaxation.

Comparison of the paediatric blade of the Pentax-AWS and Ovassapian airway in fibreoptic tracheal intubation in patients with limited mouth opening and cervical spine immobilization by a semi-rigid neck collar: a randomized controlled trial

BackgroundWe compared the performances of the paediatric blade of a Pentax Airway Scope and an Ovassapian airway in fibreoptic tracheal intubation in patients whose necks were stabilized by semi-rigid neck collars. MethodsNinety patients were enrolled in this prospective, open-label, randomized controlled trial. Patients were randomly allocated to one of two groups (Group OVA-FOB and Group AWS-FOB). The time to tracheal intubation, success rate of tracheal intubation, number of optimization manoeuvres (jaw thrust), and difficulty of manipulation of the fibreoptic bronchoscope were compared between the groups. ResultsThe time to tracheal intubation was significantly shorter (32 vs 50 s; median difference 19 s; 95% confidence interval 14–25 s; P<0.001) and manipulation of the fibreoptic bronchoscope was significantly easier for Group AWS-FOB. Optimization manoeuvres were rarely required to facilitate fibreoptic tracheal intubation in Group AWS-FOB [jaw thrust, 0 (0%); jaw thrust with anterior neck collar removal, 1 (2%)] compared with that required in Group OVA-FOB [jaw thrust, 39 (87%); jaw thrust with anterior neck collar removal, 2 (4%)]. There was no significant difference in the success rate of tracheal intubation on the first attempt between groups [Group AWS-FOB, 45 (100%); Group OVA-FOB, 44 (98%)]. ConclusionsCombined use of the paediatric blade of a Pentax Airway Scope and a fibreoptic bronchoscope enabled rapid tracheal intubation, minimizing the use of external manoeuvres of the airway, in patients with limited mouth opening and cervical spine immobilization by semi-rigid neck collars, compared with use of the Ovassapian airway and the fibreoptic bronchoscope. Clinical trial registrationNCT02827110.

The effect of Atracurium on the pulse rate during rapid tracheal intubation

The atracurium dibesilate is intermediate muscle relaxant and has a little effect on heart rate .The aim of this is project is to study the effect of atracurium dibesilate on the pulse rate during rapid tracheal intubation . Materials and method: 25 cases ASA I (American society of anesthesiology .class I) , different surgeries , the same anesthesia technique ,both sexes in AlSader teaching hospital .Result and discussion: from this study we show reading of pulse rate during three situation (pre-induction – and maintenance of anesthesia) with atracurium dibesilate during rapid tracheal intubation we notice there is not significant changes in pulse rate.Conclusion:from this project we conclude that atracurium associated with little increase in heart rate so it is preferable to be used in patients with heart diseases and elderly patients.

A Comparative Study To Evaluate The Effectiveness Of Timing Principle And Priming Principle For Tracheal Intubation Using Rocuronium

The present study is to compare the Timing principle and the Priming principle for tracheal intubation using rocuronium during balanced anesthesia by assessing the Intubating conditions and Hemodynamic changes during intubation. The succinylcholine is considered to be the best drug for rapid tracheal intubation because of its rapid onset and ultrashort duration of the action. The “priming technique” uses a sub-paralyzing dose of non-depolarizing muscle relaxant where 20% of ED 95 or 10% of the intubating dose was administered 2 to 4 min before administering an intubating dose. This technique has been proved to accelerate the onset of action by 30 to 60 seconds(5). In “timing principle” a single bolus of non-depolarizing muscle relaxant was given followed by the administration of the induction agent after the first sign of the onset of clinical weakness. The “high – dose regimen” was used when tracheal intubation has to be accomplished in less than 60 – 90 seconds(6). The study was conducted in Madras Medical College, Chennai The groups were comparable based on age and weight. Males were more in Group RP. Using the “Timing principle” with rocuronium 0.6 mg/kg consistently provides good to excellent intubating conditions at 60 seconds after the induction of anesthesia. Using the Priming principle with rocuronium 0.06 mg/kg followed by rocuronium 0.54 mg/kg consistently provides fair to good intubating conditions at 60 seconds after induction of anesthesia.

English

English

Comparison of the C-MAC video laryngoscope to a flexible fiberoptic scope for intubation with cervical spine immobilization

Study ObjectiveTo compare the C-MAC video laryngoscope to the standard flexible fiberoptic scope (FFS) with an eye piece (but without a camera or a video screen) for intubation of patients undergoing cervical spine surgery with manual inline stabilization. The primary end point was the time to achieve successful tracheal intubation. Secondary end points included glottic view at intubation and number of intubation attempts. DesignProspective, randomized, single-blinded study. SettingCedars Sinai Medical Center in Los Angeles, CA. PatientsOne hundred forty patients (American Society of Anaesthesiologists physical status I-III), aged 18 to 80years undergoing elective cervical spine surgery. InterventionPatients were prospectively randomized to undergo tracheal intubation using either an FFS (n=70) or the C-MAC video laryngoscope (n=70). MeasurementsAfter performing a preoperative airway evaluation, patients underwent a standardized induction sequence. The glottic view was assessed at the time of tracheal tube placement using the Cormack-Lehane and percentage of glottic opening scoring systems. In addition, the time required for successful insertion of the tracheal tube, number of intubation attempts to secure the airway, the need for adjuvant airway devices, hemodynamic changes, adverse events, and any airway-related trauma were recorded. Main ResultsThe glottic view at the time of intubation did not differ significantly with the 2 devices; however, the C-MAC facilitated more rapid tracheal intubation compared with the FFS (P=.001). The peak heart rate response following insertion of the tracheal tube was also reduced (P=.004) in the C-MAC (vs FFS) group. ConclusionThe C-MAC may offer an advantage over the FFS with respect to the time required to obtain glottic view and successful placement of the tracheal tube in patients requiring cervical spine immobilization.

A study of intubating conditions and haemodynamic characteristics using propofol and rocuronium after pre-treatment with ephedrine

Background and Objectives: The present study was conducted to compare the efficacy of Pre-treatment with a low dose of intravenous ephedrine 70 ?g kg-1 on the intubating conditions and its effects on hemodynamic during rapid tracheal intubation using propofol 2.5 mg kg-1 and rocuronium bromide 0.6 mg kg-1. Methodology: In this study one hundred patients were included and randomly divided into two equal groups which received either ephedrine 70 ?g kg-1 diluted to 5 ml with normal saline (Group EPR) or 5 ml of normal saline (Group SPR) 3 min prior to laryngoscopy and intubation with Propofol 2.5 mg kg-1 and rocuronium bromide 0.6 mg kg-1. A blinded anaesthesiologist assessed the intubating conditions; heart rate and mean arterial pressure before anaesthesia induction (baseline), and every minute thereafter till5 minutes post intubation. A 30% change in hemodynamic variables from baseline was regarded as clinically significant. Data were analyzed using Paired samples t-test. Results: Intubating conditions were better (p=0.023) in the ephedrine pre-treated group. There was no statistically significant difference between the ephedrine pre-treated group and control regarding the time taken for laryngoscopy and intubation. There were no significant hemodynamic changes between the two groups except tachycardia. Conclusion: Ephedrine 70 ?g kg-1 prior to induction with propofol 2.5 mg kg-1 improves intubating conditions compared to propofol alone 1 minute after 0.6 mg kg-1 rocuronium bromide injection without significant hemodynamic effects. Key Words: Ephedrine; Rocuronium; Propofol; Rapid tracheal intubation

Hemodynamic changes during tracheal intubation using propofol and rocuronium after pre-treatment with ephedrine in adult patients

Introduction: This was a prospective, randomized, placebo controlled, double blind study with the aim to determine if pre-treatment with ephedrine hydrochloride in adult patients during rapid tracheal intubation using propofol and rocuronium bromide improved intubating conditions without affecting hemodynamic parameters. Methods: One hundred adult patients, aged between 20 and 40 years, scheduled for various elective surgeries under general anesthesia were selected on the basis of a simple random sampling method. The study population was randomly divided using simple sealed envelope method into two groups, with 50 patients in each group: group EPR (ephedrine-propofol-rocuronium) and group SPR (saline-propofol-rocuronium). Patients in EPR group received ephedrine 70 µg/kg diluted to 5 ml with normal saline and the patients in SPR group received 5 ml of normal saline at the time of pre-oxygenation 3 min prior to laryngoscopy and intubation. Intubating conditions and hemodynamic parameters were assessed. Results: Pre-treatment with ephedrine hydrochloride prior to induction with propofol provided enhanced intubating conditions compared to propofol alone during rapid tracheal intubation 60 seconds after rocuronium bromide injection. However, it did not produce significant elevations of systolic and diastolic blood pressure as well as mean arterial pressure from the baseline. Pre-treatment in the EPR group resulted in an increase in the heart rate compared to the SPR group 1 min post intubation. Conclusion: The findings of the present study display that pre-treatment with ephedrine prior to propofol administration produces better intubating conditions compared to propofol alone during rapid tracheal intubation with rocuronium without significant hemodynamic changes. However, pre-treatment produced mild tachycardia, which was advantageous. It did not have any effect on the duration of laryngoscopy and the time taken for intubation.

Effect of Esmolol on variation of rate-pressure product due to tracheal intubation – An evaluation using invasive arterial pressure monitoring

Introduction: Laryngoscopy and tracheal intubation produce sympathetic over drive by catecholamine release resulting in hypertension and tachycardia. This is usually tolerated by healthy individuals but susceptible patients are likely to succumb to the hemodynamic fluctuations. Various agents are being tried to combat the intubation response over years. This study is aimed at evaluating the efficacy of Esmolol in attenuating the rise in rate- pressure product secondary to laryngoscopy and tracheal intubation. Methodology: 60 patients scheduled for general anesthesia were divided into two groups, E and C with 30 patients in each group. Hypertension, diabetes mellitus, thyroid disease, treatment with beta blockers and difficult airway constituted the exclusion criteria. Group-E patients received Esmolol 0.5mg/kg and group-C patients received normal saline[placebo] as intravenous premedication over 5min before a rapid sequence induction and tracheal intubation. Blood pressure and heart rate were measured using invasive arterial line and rate pressure product[RPP] was calculated at various time points including baseline, before induction, before intubation, at every 5sec after intubation up to 1min and at 5, 10 and 15min. Mean change in RPPs from the baseline were compared between the groups at the said time points. Results: Mean fall in RPP in Esmolol group was significantly more than that in control group at almost all the time points of measurement. Conclusion: Esmolol is effective in attenuating the hemodynamic response to laryngoscopy and tracheal intubation.

Comparison of intubating conditions during rapid tracheal intubation between Rocuronium and combination of Rocuronium with Vecuronium

Introduction: Rapid sequence induction (RSI) is usually indicated during emergency surgical procedure in the presence of full stomach and other conditions with an increased risk of aspiration. The use of succinylcholine has been the gold standard for RSI because of its rapid onset and short duration of action in spite of its adverse effects and contraindications in many conditions. Because of these side effects of succinylcholine many techniques have been attempted and published to replace succinylcholine when it is contraindicated. Aim of the study was to compare the quality of intubation conditions during tracheal intubation in 60 seconds after administration of thrice ED95 dose (0.9mg/kg) of rocuronium and combination of one &amp; half times ED95 dose (0.45mg/kg) of rocuronium and one &amp; half times ED95 dose (0.075mg/kg) of vecuronium.&#x0D; Methods: Sixty patients scheduled for elective surgery requiring tracheal intubation, age ranges from 1865 years were chosen after informed consent. Prospective, Randomized, double blind study was conducted in the Department of Anaesthesiology, Tribhuvan University Teaching Hospital.&#x0D; Results: The intubating conditions obtained with the combination groups were comparable with that of rocuronium alone. Most of the patients had excellent intubating condition and few had good intubating condition. The combination of one &amp; half ED95 dose of rocuronium &amp; one &amp; half ED95 dose of vecuronium produced either excellent or good intubating condition during RSI.&#x0D; Conclusion: Thus the combination of this drug with above dose can be an alternative to succinylcholine and rocuronium for RSI.

Effect of ephedrine on rapid intubation and haemodynamics using propofol and rocuronium: A randomized controlled trial

Ephedrine is a suitable drug to increase the cardiac output and tissue perfusion, in adequate dose, resulting in faster delivery of drug to muscles. This study was designed to compare the effect of pretreatment with ephedrine 75,100, 150 ?g/kg and saline on intubating conditions and haemodynamics during rapid tracheal intubation using propofol and rocuronium. The aim of this study was to evaluate the effects of different doses of ephedrine, given before induction, on intubating conditions and haemodynamics during rapid tracheal intubation. One hundred and twenty adult patients randomized into one of the four groups- I, II, III and IV were received iv ephedrine 75, 100, 150?g/kg and saline 0.9% (5ml) respectively, one minutes before administering propofol 2.5 mg/kg and rocuronium 0.6 mg/kg. Patients’ mean arterial pressure, heart rate, were recorded before induction (base line), just before intubation, and 1, 3, and 5 minutes after tracheal intubation. Data were analysed between the groups and within the groups using ANOVA test and X2-test. A p-value of &lt;0.05 were considered as significant. Patients characteristics, baseline heart rate, and mean arterial pressure were comparable between the groups. Iutubating conditions were significantly better in group II (p=0.002). Pulse rate at different times were statistically significant (p&lt;0.001) except base line and just before intubation. The mean difference of average mean blood pressure at different times were statistically significant (p&lt;0.05) except baseline. In conclusion, pre-treatment with ephedrine 100 ?gm/kg improved the intubating conditions during rapid tracheal intubation using propofol and rocuronium. DOI: http://dx.doi.org/10.3329/jbsa.v22i1.18096 Journal of BSA, 2009; 22(1): 16-20

Comparison of intubating conditions and haemodynamic responses during rapid tracheal intubation using either suxamethonium or rocuronium with ephedrine pretreatment

Background: Suxamethonium is considered as the “gold standard” for tracheal intubation. Because of innumerable contraindications for the use of this drug, there is a continuous search for other alternatives. Methods: In a prospective, randomized and double-blind study, we compared the intubating conditions and haemodynamic responses during rapid tracheal intubation using either suxamethonium or rocuronium with ephedrine pretreatment. We recruited 50 patients and allocated them into 2 groups (n= 25 each); Group S: received suxamethonium 1.5 mg/kg and Group R: received rocuronium 0.6 mg/ kg with ephedrine 100 μg/kg pretreatment. All patients were induced with 2 mg/kg propofol and intubation was attempted at 60 seconds. Haemodynamic responses and quality of intubating conditions were assessed. Results: Both groups were comparable in respect to age, sex, weight, Mallampati grade, Cormack Lehane grade and duration of laryngoscopy. Although both groups had clinically acceptable intubating conditions (good and excellent), there were more number of patients with better intubation score in Group S compared to Group R (p = 0.014). Conclusion: Suxamethonium still continues to be the “gold standard” for providing ideal tracheal intubation conditions. However, in conditions where suxamethonium is contraindicated, rocuronium-ephedrine combination can be used as an alternative to intubate the trachea at 60 seconds.

Dose of rocuronium for rapid tracheal intubation following remifentanil 2 μg kg−1 and propofol 2 mg kg−1

Full relaxation is not mandatory for successful tracheal intubation. We tried to find the dose of rocuronium that gave acceptable intubation conditions in a rapid sequence intubation with remifentanil and propofol. A dose-finding study of rocuronium using a modified Dixon's up-and-down method. A single tertiary care teaching hospital. Patients undergoing elective surgery under general anaesthesia. After premedication with midazolam and glycopyrrolate, anaesthesia was induced using remifentanil 2 μg kg and propofol 2 mg kg, and a predetermined dose of rocuronium was administered. The dose of rocuronium was determined by a modified Dixon's up-and-down method starting from 0.8 mg kg with an interval of 0.1 or 0.05 mg kg. Intubation was performed 60 s after the start of the rocuronium injection. Intubation conditions were graded as excellent, good or poor. Excellent or good were regarded as clinically acceptable. A dose of rocuronium needed for acceptable intubation condition in 50% of patients (ED50) during rapid tracheal intubation after induction of anaesthesia with remifentanil and propofol. Twenty-eight patients were enrolled to obtain six crossovers. The ED50 of rocuronium was 0.20 mg kg (95% confidence interval, CI 0.17 to 0.23 mg kg) by a modified Dixon's up-and-down method. After induction of anaesthesia with remifentanil 2 μg kg and propofol 2 mg kg, the ED50 of rocuronium for acceptable intubation condition was 0.20 mg kg (95% CI, 0.17 to 0.23 mg kg) for rapid sequence intubation. Thus, we recommend that the intubation dose should be 0.8 mg kg. Clinical trial registration KCT0000094.

Difficult intubation assessment using statistical factor analysis decision tree

Correct and rapid tracheal intubation is an essential anesthesia task for surgical operations. Intubation highly depends on the subjective judgment and experience of the anesthetist. This paper proposes a statistical factor analysis approach to model the preferences of expert anesthetists to enable more accurate pre-operation judgments in cases of difficult intubation. Factor analysis combined with the mutual information between factors is used to generate a robust decision tree (DT) using Bartlett’s node splitting criterion for better decision-making. A tablet computer application is also developed to assist judgment. Several experiments were performed to investigate judgment accuracy and learning effects. Our proposed approach outperformed both a well-known C5.0 DT and an expert opinion derived DT. Encouraging results concerning robustness and efficiency were observed for our approach.

The Usefulness of 3-Dimensional Virtual Simulation Using Haptics in Training Orotracheal Intubation

Objectives. Airway control is the most critical treatment. The most common and basic method of endotracheal intubation is orotracheal intubation. To perform accurate and rapid tracheal intubation, appropriate education and training are required. We developed the virtual simulation program utilizing the 3-dimensional display and haptic device to exercise orotracheal intubation, and the educational effect of this program was compared with that of the mannequin method. Method. The control group used airway mannequin and virtual intubation group was trained with new program. We videotaped both groups during objective structured clinical examination (OSCE) with airway mannequin. The video was reviewed and scored, and the rate of success and time were calculated. Result. The success rate was 78.6% in virtual intubation group and 93.3% in control group (P = 0.273). There was no difference in overall score of OSCE (21.14 ± 4.28 in virtual intubation group and 23.33 ± 4.45 in control group, P = 0.188), the time spent in successful intubation (P = 0.432), and the number of trials (P > 0.101). Conclusion. The virtual simulation with haptics had a similar effect compared with mannequin, but it could be more cost effective and convenient than mannequin training in time and space.

Optimal Remifentanil Dosage for Intubation without Muscle Relaxants in Elderly Patients

Remifentanil used in combination with propofol provides adequate conditions for tracheal intubation without muscle relaxants. Delivery of the optimal dose is important to prevent poor intubation conditions and drug-related complications. No previous study has investigated the use of a remifentanil-propofol combination in elderly patients. The aim of the present study was to determine the dose of remifentanil necessary for rapid tracheal intubation without the use of muscle relaxants in elderly patients. A total of 24 patients >65 years of age with American Society of Anesthesiologists status I-II who were scheduled to undergo elective surgery under general anaesthesia were enrolled. After premedication with glycopyrrolate and midazolam, anaesthesia was induced with 1 mg/kg propofol, and a blinded dose of remifentanil was then infused over 30 s after confirming the patient's loss of consciousness. The remifentanil dose was determined using Dixon's up-and-down method, starting at 2 µg/kg. Intubation was performed 60 s after the loss of consciousness. Intubation conditions were assessed with the Stockholm score and an assessment of excellent or good condition was regarded as being clinically acceptable. The effective dose needed for acceptable intubation conditions in 50 % of the subjects (ED(50)) was determined by Dixon's up-and-down method, and the ED(50) and the effective dose needed for acceptable intubation conditions in 95 % of the subjects (ED(95)) with 95 % confidence intervals (CIs) were determined by probit analysis. In total, 24 patients were recruited and the median age (interquartile range) was 70 (66-74) years. The ED(50) of remifentanil for tracheal intubation was 1.15 (standard deviation 0.13) µg/kg. The ED(50) and ED(95) of remifentanil obtained from the probit analyses were 1.16 (95 % CI 1.01, 1.29) µg/kg and 1.39 (95 % CI 1.27, 2.13) µg/kg, respectively. Blood pressure and heart rate decreased significantly after propofol and remifentanil administration, but were within 30 % of baseline values. Combined with 1 mg/kg propofol, 1.39 (95 % CI 1.27, 2.13) µg/kg remifentanil resulted in acceptable intubation conditions within 60 s in 95 % of elderly patients without major complications.

Variation de kaliémie après une induction en séquence rapide avec la succinylcholine chez les patients de réanimation

ObjectiveEvaluate the changes in potassium following rapid sequence induction with succinylcholine in critically ill-patients and determine whether hospital length of stay could influence the succinylcholine-induced hyperkaliemia. Study designProspective and observational study. Patients and methodsAfter approval by our local ethical committee, we prospectively included 36 patients admitted from more than 24hours in ICU and who required succinylcholine for rapid tracheal intubation (1mg/kg). Serum potassium was measured before, 5 and 30min after succinylcholine. The incidence of life-threatening hyperkaliemia (≥6.5mmol/L) was noted. ResultsWe could observe significant and transient increase in serum potassium (median increase of 0.45 [0.20–0.80] mmol/L at five minutes). A significant relationship was observed between the ICU length of stay and arterial potassium increase (r=0.37, P<0.05). From the ROC curve, a threshold of 12 days had an 86% sensitivity and 69% specificity in discriminating patients in whom the potassium increase was more than 1.5mmol/L. ConclusionInduction with succinylcholine is followed by significant but transient hyperkaliema. The ICU length of stay before giving succinylcholine could influence significantly the amplitude of potassium increase.

Effects of skeletal muscle denervation on potency of rocuronium

Abstract Background: Rocuronium is an alternative to succinylcholine for rapid tracheal intubation after major thermal injury and other forms of critical illness that cause denervation changes in skeletal muscle. Rocuronium may decrease the potencies of non-depolarizing muscle relaxants. Objectives: Examine whether potency of rocuronium changed during the first month after denervation, and investigate the effects of skeletal muscle denervation on potency of rocuronium. Methods: The denervation mouse model was developed to create denervated individual cells from the flexor digitorum brevis of the hindfoot. The skeletal muscle cells were examined at day 0 in the innervated control and days 1, 4, 7, 14, 21, and 28 in the denervation group. Nicotinic acetylcholine receptors in the cells were activated with 30 M acetylcholine, alone or in combination with various concentrations of rocuronium. Currents were recorded with a whole-cell patch-clamp technique. Results: Rocuronium reversibly inhibited acetylcholine-activated currents in a dose-dependent fashion at different times after denervation. The inhibition concentration for the half-maximal responses of rocuronium increased 1.2- (p &gt;0.05), 1.8-, 2.8-, 2.3-, 2.1-, and 1.9-fold (p &lt;0.01) at day 1, 4, 7, 14, 21, and 28 after denervation, respectively, compared to that at day 0 after denervation. Conclusion: Rocuronium dose required to achieve satisfactory clinical effects changed at different durations after skeletal muscle denervation.