Rocuronium For Rapid Sequence Induction Research Articles

Rocuronium versus Cisatracurium for Rapid Sequence Induction of Anesthesia in Morbidly Obese Patients

Introduction and Aim: Obesity is a challenging problem for anesthetists. Difficult airway with risk of aspiration and regurgitation increases with obesity. Therefore, the need for effective and safe drug for rapid induction of anesthesia is crucial to ensure fast good intubation condition. The aim of this study is to assess Rocuronium versus Cisatracurium for rapid sequence induction of anesthesia in morbidly obese patients.
 Patients and methods: This study included 60 patients with ASA physical status II, aged 21-40 years, BMI 35-40 kg/m2 and scheduled for elective surgery under general anesthesia. Patients were classified into two equal groups: Group (R): received Rocuronium bromide (Esmeron) in a dose of 0.9 mg/kg (lean body mass) for intubation; Group (C): received Cisatracurium besylate (Nimbex) in a dose of 0.15 mg/kg (LBM) for intubation. Timing of intubation in seconds, intubation score (excellent, good, poor, or inadequate), and hemodynamic variables before induction (baseline), after induction and before injection of Neuro-muscular blocker (NMB), after injection of NMB and before endotracheal intubation and just after intubation were assessed and measured.
 Results: There was statistically significant decrease in the timing of intubation in R group (84.0 ± 18.50) as compared to C group (96.0 ± 13.29). However, there was no statistically significant difference in the intubation score among the two groups. There was significant decrease in heart rate and mean arterial blood pressure after the induction of anaesthesia as compared to the baseline in both groups; Heart rate and mean arterial blood pressure changes were comparable among the two groups all of the time.
 Conclusion: Rocuronium for rapid sequence induction in morbidly obese patients is associated with faster onset compared with cisatracurium, with comparable intubation condition and hemodynamic variables. We recommend further studies to be conducted for evaluation of both drugs with different doses.

Comparison between Rocuronium and Succinylcholine for Rapid Sequence Induction in Adult: Experience of A Referral Hospital in Central Africa

Background: A l’état actuel des connaissances, l’ISR reste le meilleur compromis pour l’intubation des patientts à estomac plein. Le curare de référence reste la succinylcholine à la posologie de 1 mg/kg. En cas de contre-indication, le rocuronium (1,2 mg/kg) peut être utilisé si l’on possède son antidote: le sugammadex utilisé pour lever la curarisation en cas de difficulté d’intubation. Aim of study: the aim of study was to describe and compare the intubation conditions offered by succinylcholine and rocuronium in rapid sequence induction at the Essos hospital in Cameroon. Methods: This was a descriptive, prospective and comparative study, randomized single-blind, from June 2018 to January 2019. It took place in the anesthesia-intensive care unit of the Essos hospital in Cameroon. The adult patients, seen in consultation with anesthesia for urgent surgery under general anesthesia with RSI were included in the study. The patients were randomly divided into two groups: celocurine group (1mg/kg) and rocuronium group (1,2mg/kg). For each patient, the tracheal intubation conditions were assessed according to the score proposed by the work of Viby-Mongensen et al in 1999. Data were entered from Microsoft Word 2016 software, and were analyzed using SPSS 20.0 software. Results: The cohort was predominantly young with 44.28% of ASA I class participants and 37.5% of ASA II class. Fasciculations were the main side effect (42.85%) experienced by patients in the celocurine group, followed by hypotension (17.14%) and tachycardia (8.57%). The main side effects of patients in the rocuronium group were hypotension (5.71%) and bradycardia (2.85%). The intubation conditions were "excellent" in 90% of cases and "good" in 10% of cases in both groups. Conclusion: Rocuronium and succinylcholine provide excellent and acceptable intubation conditions with minimal side effects.

In Response.

In Response.

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.
 Design: Randomized control trial.
 Place and duration of study: Department of anesthesiology and pain medicine, Combined Military Hospital Malir Cantt Karachi from 25th June to 10th August 2019.
 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.
 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.
 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.

Rocuronium Versus Cis-Atracurium in Rapid Sequence Induction of Morbidly Obese Patients; Prospective Randomized Clinical Trial

Abstract Background: The use of larger doses of neuromuscular blockers may shorten the onset of intubation. Aim of Study: This study aimed to evaluate the use of triple the (ED95) of rocuronium or cis-atracurium on the timing and the score of intubation in morbidly obese patients. Patients and Methods: Sixty adult morbid obese patients were included in this study and allocated randomly according to the muscle relaxant used for induction of anesthesia into either ROC group; in which 0.9mg/kg of rocuronium was used or CIS group; in which 0.15mg/kg of cis-atracurium was used. The onset and the duration of relaxation, the time of intubation, the intubation score, and the incidence of compli-cation were measured. In addition, the changes in the hemo-dynamic parameters were recorded. Results: In comparison to cis-atracurium, the use of triple (ED95) of rocuronium in rapid sequence induction of anesthesia significantly shortened the onset of relaxation from 96.00±13.29 to 84.00±18.50sec (p=0.005, CI 3.675; 20.325), and the time of intubation from 104.55±17.91 to 89.14±20.43 sec (p=0.002, CI 6.00; 24.82). However, the duration of relaxation was significantly prolonged from 58.76±9.27 to 69.86±8.38min (p=0.003, CI 2.533; 11.667). Moreover, the intubation score was comparable between the two groups (p=0.994). Conclusion: The use of triple the (ED95) of rocuronium as compared to cis-atracurium in rapid sequence induction of anesthesia of morbidly obese patients significantly shortened the onset of relaxation and the time of inubation with an insignificant effect on the intubation score. Clinical trial registration: Pan African Clinical Trial Registry (PACTR201703002147145) (www.pactr.org).

Comparison of vecuronium or rocuronium for rapid sequence induction in morbidly obese patients: a randomized study

ABSTRACT Background This trial aimed to evaluate the effect of the use of triple the ED95 of rocuronium and vecuronium on the onset of relaxation and the intubation score in morbidly obese patients. Methods Sixty adult morbidly obese patients were included in this trial and were randomly assigned according to the muscle relaxants used to the ROC group, in which patients received rocuronium (0.9 mg/kg), and VEC group, in which the patients received vecuronium (0.15 mg/kg). The onset and duration of relaxation, the time of intubation, and the intubation scores were assessed. Additionally, the response of hemodynamic parameters to the injection of muscle relaxants and to the intubation was recorded. Results The onset of relaxation was significantly lower in ROC group (57.5 ± 19.9 sec) than in VEC group (105.0 ± 18.8 sec) (P < 0.0001). Additionally, the time for intubation was significantly shorter in ROC group (69.00 ± 19.4 sec) than in VEC group (120.8 ± 17.7 sec) (P < 0.0001). Moreover, there was a significant increase in the duration of relaxation in ROC group (85.5 ± 19.2 min) compared with VEC group (72.00 ± 22.65 min) (P = 0.016). However, there was no significant difference between the two groups in the intubation score (P = 0.656) and the changes in the hemodynamic parameters (P > 0.05). Conclusion The use of triple the ED95 of rocuronium in morbidly obese patients significantly shortened the onset of relaxation and the timing of intubation compared to vecuronium. However, the intubation score and the hemodynamic changes during intubation were comparable.

Suxamethonium or rocuronium for rapid sequence induction of anaesthesia? A reply

Suxamethonium or rocuronium for rapid sequence induction of anaesthesia? A reply

Rocuronium vs suxamethonium for rapid sequence induction.

British Journal of Hospital MedicineVol. 77, No. 4 RegularsRocuronium vs suxamethonium for rapid sequence inductionTimothy Knowles, Rebecca SmithTimothy KnowlesSearch for more papers by this author, Rebecca SmithSearch for more papers by this authorTimothy Knowles; Rebecca SmithPublished Online:13 Apr 2016https://doi.org/10.12968/hmed.2016.77.4.254AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Frerk C, Mitchell VS, McNarry AF et al. (2015) Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 115(6): 827–48 (doi: https://doi.org/10.1093/bja/aev371) Crossref, Medline, Google ScholarJoint Formulary Committee (2015) British National Formulary. BMJ Group and Pharmaceutical Press, London Google ScholarSadleir PHM, Clarke RC, Bunning DL, Platt PR (2013) Anaphylaxis to neuromuscular blocking drugs: incidence and cross-reactivity in Western Australia from 2002 to 2011. Br J Anaesth 110(6): 981–7 (doi: https://doi.org/10.1093/bja/aes506) Crossref, Medline, Google ScholarSorensen MK, Bretlau C, Gatke MR, Sorensen AM, Rasmussen LS (2012) Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. Br J Anaesth 108(4): 682–9 (doi: https://doi.org/10.1093/bja/aer503) Crossref, Medline, Google ScholarTran DTT, Newton EK, Mount VAH, Lee JS, Wells GA, Perry J (2015) Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev 10: CD002788 (doi: https://doi.org/10.1002/14651858.CD002788.pub3) Medline, Google ScholarWallace C, McGuire B (2014) Rapid sequence induction: its place in modern anaesthesia. Contin Educ Anaesth Crit Care Pain 14(3): 130–5 (doi: https://doi.org/10.1093/bjaceaccp/mkt047) Crossref, Google Scholar FiguresReferencesRelatedDetailsCited byEffects of neuromuscular blocking drugs on viability of human umbilical vein endothelial cells (HUVECs)26 June 2020 | Journal of International Medical Research, Vol. 48, No. 6 2 April 2016Volume 77Issue 4ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 13 April 2016 Published in print 2 April 2016 Information© MA Healthcare LimitedPDF download

Succinylcholine vs. rocuronium for rapid sequence induction

Succinylcholine vs. rocuronium for rapid sequence induction

Comparative study between succinylcholine, rocuronium and magnesium sulphate with rocuronium in rapid sequence induction

Background Rapid sequence induction usually applies when tracheal intubation must be performed in a patient who is suspected of having a full stomach and who is at risk of pulmonary aspiration of gastric contents. Succinylcholine is the traditional depolarizing neuromuscular-blocking agent used in rapid sequence induction. However, it has a number of undesirable side effects. Magnesium may have a role in potentiation of neuromuscular blockade produced by neuromuscular blockers such as rocuronium. Aim The aim of this study was to investigate the effects of magnesium sulphate pretreatment on intubating conditions and cardiovascular responses during rapid sequence tracheal intubation (RSI). Patients and methods A total of 60 adult patients were randomly allocated to three groups: the succinylcholine group, which received 1 mg/kg succinylcholine; the rocuronium group, which received 1.2 mg/kg rocuronium preceded 15 min with 500 ml normal saline; and the magnesium rocuronium group, which received 1.2 mg/kg rocuronium preceded 15 min with 60 mg/kg magnesium sulphate in 500 ml normal saline infusion. Anaesthesia was induced with fentanyl, propofol and a neuromuscular-blocking drug on the basis of the studied group. An anaesthesiologist, blinded to the rocuronium group assignments, performed RSI and assessed the onset time, intubating conditions and clinical duration of neuromuscular block in the different groups. Haemodynamics were recorded before magnesium sulphate or normal saline infusion, after anaesthesia induction and every minute after intubation for 5 min. Results The onset time was shortest in the succinylcholine and magnesium groups. The intubating conditions were significantly better in the magnesium group (P Conclusion Magnesium sulphate administered before RSI using fentanyl, propofol and rocuronium may shorten the onset time and improve the intubating conditions comparable to those of succinylcholine and suppress the haemodynamic stress response to 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.

Rocuronium for rapid sequence induction in morbidly obese patients

Rocuronium for rapid sequence induction in morbidly obese patients

Can sugammadex save a patient in a simulated ‘cannot intubate, cannot ventilate’ scenario?

We read with great interest the recent article by Bisschops et al. [1] and would like to commend the writers for highlighting this problem. We suspect the situation will be similar in most theatre units that store sugammadex. We would like to point out that suxamethonium remains the gold standard in respect of speed of reversal of neuromuscular blockade. Typically, suxamethonium is metabolised between five and eleven minutes, allowing return of neuromuscular function [2]. Rarely, this can be longer in the presence of atypical pseudocholinesterases. Bisshops et al. found a total time of 8.9 min to reverse the effect of rocuronium, i.e. 6.7 min to administer sugammadex plus 2.2 min for appearance of train-of-four ratio of 0.9. One might conclude that there is no significant difference in time to achieve reversal. However, this assumes that the process of obtaining the drug, drawing up the appropriate dose and administering it, all happen without a delay. Using suxamethonium abolishes all these potential delays. Taha et al. [3] recently showed that the median (IQR) time to onset of haemoglobin desaturation during apnoea following administration of propofol and suxamethonium for rapid sequence induction was 242 (225–258) s. These patients were fit with a normal body mass index; obese and very sick patients will desaturate more quickly. In fact, Benumof et al. [4] suggested critical desaturation within 3.1 min in obese patients (using mathematical models). Clearly, time taken for either spontaneous reversal of suxamethonium or pharmacological reversal of rocuronium is critical in the face of rapidly falling haemoglobin saturations. The Difficult Airway Society recommended that treatment during a ‘cannot intubate, cannot ventilate’ (CICV) scenario, after failure of appropriate airway manoeuvres and supraglottic devices, is the insertion of a kink-resistant cannula into the trachea and ventilation of the lungs with a high-pressure ventilation system [5]. Unfortunately, there is a lack of skill and experience in the practice of this technique, and in a recent survey only 37% of respondents chose the recommended airway rescue technique in a hypothetical CICV situation [6]. Sugammadex may increase our treatment options when faced with a CICV situation but it is not necessarily going to solve the problem. We believe more time and training should be devoted to teaching anaesthetists and other physicians involved in airway management how to oxygenate patients adequately. We agree that sugammadex should be readily available and easily accessible in all theatres where rocuronium is used routinely, especially if used for rapid sequence induction. However, the cost implications may discourage many hospitals [7]. If individual anaesthetic departments choose to sanction the use of rocuronium for rapid sequence induction, then it may be considered negligent not to have sugammadex readily available. Practitioners still have limited knowledge regarding the appropriate doses of sugammadex. As with all emergency drugs, clear instructions detailing the correct reversal dosage should be clearly visible in areas where rocuronium is administered. Perhaps sugammadex should be stored centrally but should be accessed before starting a case involving a suspected difficult airway. This would not solve the problem of an unanticipated CICV situation. We would therefore like to emphasise the need for more widespread and ongoing training in the proper management of the CICV scenario. As this scenario is very rare in clinical practice, a case can also be made for regular drills amongst teams managing such cases. No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.

The optimal dose of rocuronium for rapid sequence induction

To the Editor, In their study using lidocaine, low-dose rocuronium, remifentanil, and propofol for tracheal intubation, SiddikSayyid et al. found tracheal intubation conditions 90 sec after rocuronium 0.3 mg kg to be comparable to those achieved 60 sec following succinylcholine 1.5 mg kg. The onset of neuromuscular block is a function of the dose given. Using electromyography, the onset of rocuronium 0.6 mg kg at the laryngeal adductors was found to be 106 sec in one study and 124 sec in another. The onset of lower doses is further delayed and can be too slow for rapid sequence induction purposes. Higher doses (1 mg kg) are recommended when rapid tracheal intubation is indicated. Low doses will also result in a less intense block at the laryngeal adductors, which are known to be more resistant than skeletal muscles to the action of rocuronium. Using a 0.25 mg kg dose, Meistelman et al. found the maximum block attained at the vocal cords to be only 37 ± 8%. Thus, low doses may only result in a delayed and partial laryngeal block. The authors’ favourable results are due to their strict adherence to the described induction technique. As pointed out in the accompanying editorial, minor deviations from that technique may lead to different results, including failure to achieve tracheal intubation due to poor relaxation and inadequate intubation conditions. This may increase the risk of aspiration during the rapid sequence induction which the technique was originally instituted to guard against. The authors are to be commended for describing a technique that can be advantageous for brief surgical procedures that require muscle relaxation. A Cochrane database review, however, showed that the optimal dose of rocuronium for rapid sequence induction probably should be higher than 1 mg kg.

Sugammadex: Another Milestone in Clinical Neuromuscular Pharmacology

Sugammadex is a revolutionary investigational reversal drug currently undergoing Phase III testing whose introduction into clinical practice may change the face of clinical neuromuscular pharmacology. A modified gamma-cyclodextrin, sugammadex exerts its effect by forming very tight water-soluble complexes at a 1:1 ratio with steroidal neuromuscular blocking drugs (rocuronium > vecuronium >> pancuronium). During rocuronium-induced neuromuscular blockade, the IV administration of sugammadex creates a concentration gradient favoring the movement of rocuronium molecules from the neuromuscular junction back into the plasma, which results in a fast recovery of neuromuscular function. Sugammadex is biologically inactive, does not bind to plasma proteins, and appears to be safe and well tolerated. Additionally, it has no effect on acetylcholinesterase or any receptor system in the body. The compound's efficacy as an antagonist does not appear to rely on renal excretion of the cyclodextrin-relaxant complex. Human and animal studies have demonstrated that sugammadex can reverse very deep neuromuscular blockade induced by rocuronium without muscle weakness. Its future clinical use should decrease the incidence of postoperative muscle weakness, and thus contribute to increased patient safety. Sugammadex will also facilitate the use of rocuronium for rapid sequence induction of anesthesia by providing a faster onset-offset profile than that seen with 1.0 mg/kg succinylcholine. Furthermore, no additional anticholinesterase or anticholinergic drugs would be needed for antagonism of residual neuromuscular blockade, which would mean the end of the cardiovascular and other side effects of these compounds. The clinical use of sugammadex promises to eliminate many of the shortcomings in our current practice with regard to the antagonism of rocuronium and possibly other steroidal neuromuscular blockers.

Airway Injury with Low-Dose Rocuronium Versus Succinylcholine for Rapid-Sequence Induction: Relevance and Ethics

In Response: Dr. Wax questions (1) whether our study (2) provides clinically relevant information. Our aim was to define the incidence and severity of hoarseness, sore throat, and vocal cord injuries in patients receiving succinylcholine or rocuronium for rapid-sequence induction. Our first study (3) showed that excellent intubating conditions were associated with the lowest incidence of laryngeal morbidity. We wanted to determine if these results could be transferred to an emergency rapid-sequence induction. Our results indicate that laryngeal morbidity does not correlate with the intubating conditions during rapid-sequence induction. Because this study was done under real rapid-sequence inductions, the results are clinically relevant. Although succinylcholine produced better intubating conditions, the incidence of tracheal injury was similar in both groups. The rocuronium package insert (July 2005) states that 0.6–1.2 mg/kg is the appropriate dose for rapid-sequence induction. Our dosing and terminology are consistent with the package insert. The package insert defines “low dose” rocuronium as a dose of 0.45 mg/kg. Dr. Wax’s characterization of our dose as “low” is inconsistent with rocuronium’s product labeling. Thomas Mencke, MD Gabriele Noeldge-Schomburg Department of Anaesthesia and Intensive Care Medicine University of Rostock Rostock, Germany [email protected] or [email protected] Heike Knoll, MD Department of Anaesthesia and Intensive Care Medicine University of the Saarland Homburg/Saar, Germany

Effects of Intravenous Induction Drugs on Intubation Conditions Using Rocuronium for Rapid Sequence Induction

Background: We assessed the effect of intravenous induction agents on intubation conditions and hemodynamic changes when using rocuronium 0.7 mg/kg for rapid sequence induction. Methods: Sixty ASA class I or II patients undergoing elective surgery were divided into a thiopental group (5 mg/kg, n = 20), a propofol group (2 mg/kg, n = 20) and an etomidate group (0.2 mg/kg, n = 20). Anesthesia was induced with intravenous induction agents. After loss of consciousness, rocuronium 0.7 mg/kg was injected. Intubation was attempted at 60 seconds after rocuronium administration. Arterial blood pressure and heart rate were measured before induction, immediately after intubation, and 1, 3, 5, and 10 minutes after intubation. Intubation conditions were assessed by jaw relaxation, vocal cord movement, response to tracheal intubation, and were evaluated as excellent, good, fair, and poor. Results: Excellent intubation conditions were obtained 55% (n = 11) in the thiopental group, 60% (n = 12) in the propofol group, and 45% (n = 9) in the etomidate group. Systolic and diastolic arterial blood pressures were elevated after intubation in all three groups. But these changes were minimal in the propofol group. Conclusions: Intubation conditions were not significantly different after the intravenous injection of thiopental 5 mg/kg, propofol 2mg/kg, or etomidate 0.2 mg/kg when using rocuronium 0.7 mg/kg for rapid sequence induction.

Succinylcholine or rocuronium for rapid sequence induction

Succinylcholine or rocuronium for rapid sequence induction

Comparison of Succinylcholine and Rocuronium for Rapid-sequence Induction of Anesthesia

Comparison of Succinylcholine and Rocuronium for Rapid-sequence Induction of Anesthesia