Single Dose Of Rocuronium Research Articles

Effect of tetanic stimulation prior to train-of-four monitoring on the time to muscle response stabilization with neuromuscular blockade with rocuronium in patients aged 60 to 80 years: A prospective randomized controlled trial.

To determine the effect of tetanic stimulation on the time to achieve stabilization of the T1 height, by acceleromyography train-of-four (TOF) ratio monitoring, in patients aged 60 to 80 years. Randomized, prospective, single-blind, controlled trial in patients aged 60 to 80 years undergoing elective surgery under general anesthesia in two university hospitals in Brazil between December 2019 and March 2022. This trial was performed in accordance with the principles of the Helsinki Declaration and the guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II. Participants were randomly allocated by computer-generated numbers to receive tetanic stimulation (intervention group, n = 25) or not receive tetanic stimulation (control group, n = 25) to achieve T1 height stabilization on TOF ratio monitoring. The primary endpoint was to evaluate the effect of tetanic stimulation on the time to achieve stabilization of the T1 height. We also evaluated the effect on the onset time of rocuronium and time to recover from neuromuscular blockade with a single dose of rocuronium 0.6 mg.kg-1 with spontaneous recovery. There was no statistically significant difference between the groups in the time to T1 height stabilization (intervention: 4.3 [2.0-8.0] min; control: 5.8 [2.0-10.5] min; p = 0.202), onset time of the neuromuscular blocking agent (intervention: 1.9 [±0.7] min; control: 2.2 [±1.0] min; p = 0.219), or neuromuscular blockade recovery times to normalized TOF values of 0.7 (intervention: 106.1 [±37.2] min; control: 91.7 [±27.5] min; p = 0.295), 0.8 (intervention: 114.3 [±40.1] min; control: 97.8 [±28.9] min; p = 0.225), 0.9 (intervention: 126.5 [±44.0] min; control: 106.9 [±30.6] min; p = 0.153), and 1.0 (intervention: 138.3 [±43.4] min; control: 123.8 [±43.5] min; p = 0.425). The results of this study suggest that the recommendation to use tetanic stimulation to shorten the time to T1 height stabilization in neuromuscular monitoring did not alter the stabilization time of the T1 twitch or the pharmacodynamics of neuromuscular blockade with rocuronium in patients aged 60 to 80 years.

A study on the appropriate dose of rocuronium for intraoperative neuromonitoring in Da Vinci robot thyroid surgery: a randomized, double-blind, controlled trial.

This study was to explore the effect of different doses of rocuronium bromide on neuromonitoring during Da Vinci robot thyroid surgery. This was a prospective, randomized, double-blind, controlled trial that included 189 patients who underwent Da Vinci robot thyroidectomy with intraoperative neuromonitoring(IONM). Patients were randomly divided into three groups and given three different doses of rocuronium (0.3mg/kg, 0.6mg/kg, 0.9mg/kg). Outcome measurements included IONM evoked potential, postoperative Voice Handicap Index-30(VHI-30), intraoperative body movement incidence rate, Cooper score, and hemodynamic changes during anesthesia induction.Results: The difference in IONM evoked potentials at various time points between the three groups was not statistically significant (P>0.05). The difference in Cooper scores and intraoperative body movement incidence rate between 0.6 and 0.9mg/kg groups was statistically significant compared with the 0.3mg/kg group (both P<0.001). There was no statistically significant difference in VHI-30 score and hemodynamic changes during anesthesia induction among the three groups (both P>0.05). For patients undergoing Da Vinci robot thyroidectomy, a single dose of rocuronium at 0.6 and 0.9mg/kg during anesthesia induction can provide stable IONM evoked potential. Additionally, compared to 0.3 mg/kg, it can offer better tracheal intubation conditions and lower incidence of body movements during surgery. It is worth noting that the use of higher doses of rocuronium should be adjusted based on the duration of IONM and local practices.

Recurarization with magnesium sulfate administered after two minutes sugammadex reversal: A randomized, double-blind, controlled trial

Study objectiveThe current study tested the hypothesis that magnesium sulfate after reversal with sugammadex causes recurarization. DesignA single-center, prospective, randomized, double-blind, controlled trial. SettingTerciary care hospital in Rio de Janeiro, Brazil. PatientsIncluded 60 patients undergoing for elective otolaryngological surgery. InterventionsAll patients received total intravenous anesthesia and a single dose of rocuronium (0.6 mg/kg). In 30 patients, the neuromuscular blockade was reversed with sugammadex (4 mg/kg) at the reappearance of one or two posttetanic counts (deep-blockade series). In 30 other patients, sugammadex (2 mg/kg) was administered at the reappearance of the second twitch of the train-of-four (moderate-blockade series). After the normalized train-of-four ratio recovered to ≥0.9, the patients in each series were randomized to receive intravenous magnesium sulfate (60 mg/kg) or placebo for 10 min. Neuromuscular function was measured by acceleromyography. MeasurementsThe primary outcome was the number of patients who exhibited recurarization (normalized train-of-four ratio < 0.9). The secondary outcome was rescue with an additional dose of sugammadex after 60 min. Main resultsIn the deep-blockade series, a normalized train-of-four ratio < 0.9 occurred in 9/14 (64%) patients receiving magnesium sulfate and 1/14 (7%) receiving placebo, RR 9.0 (95% CI: 62–1.30), and (p = 0.002), with four rescues with sugammadex. In the moderate-blockade series, neuromuscular blockade recurred in 11/15 (73%) patients receiving magnesium sulfate and in 0/14 (0%) receiving placebo (p < 0.001), with two rescues. The absolute differences in recurarization were 57% and 73% in the deep-blockade and moderate-blockade, respectively. ConclusionsSingle-dose magnesium sulfate led to a normalized train-of-four ratio < 0.9, 2 min after recovery from rocuronium-induced deep and moderate neuromuscular blockade using sugammadex. Additional sugammadex reversed prolonged recurarization.

Dexmedetomidine as an adjuvant to scalp block in patients undergoing elective craniotomy: A prospective randomized controlled trial.

Regional techniques minimize anesthetic requirements and their effects may be beneficial. There is a lack of consensus and evidence concerning alternative analgesia strategies for cranial neurosurgery. This study was designed to evaluate the effect of scalp block with or without dexmedetomidine combined with general anesthesia on hemodynamic stability, opioid consumption and postoperative pain in patients undergoing elective craniotomy. One hundred five patients undergoing elective craniotomy for tumor dissection were randomly divided into three groups to receive scalp block as an adjuvant to general anesthesia: with either 40ml ropivacaine 0.5% (Group R), 40ml ropivacaine 0.5% plus dexmedetomidine 1μg/kg (Group RD) or 40ml saline as a placebo (Group C). After a standard induction sequence using propofol, fentanyl and a single dose of rocuronium, patients were intubated. Bilateral scalp block was given immediately after induction. Anesthesia was maintained with propofol and remifentanil infusion. Five minutes before head pinning scalp block was performed by blocking the supraorbital, supratrochlear, auriculotemporal, occipital, and postauricular branches of the greater auricular nerves. All patients were monitored with electrocardiogram, invasive blood pressure, pulse oximetry and BIS monitoring. Primary outcomes measures were overall hemodynamic variables during surgery and intravenous fentanyl and remifentanil consumption. Mean arterial pressure (MAP) and heart rate (HR) were recorded at seven time-points: scalp block (T1-baseline), pin fixation (T2), skin incision (T3), drilling (T4), dura matter incision (T5), dura matter closure (T6) and skin closure (T7). For all time points it was recorded the mean value after 3 consecutive measures with 5min interval. Secondary outcome was postoperative pain intensity using visual analog scale 24 and 48h after surgery. VAS scores, fentanyl and remifentanil were evaluated using Kruskal-Wallis test. MAP and HR were compared by One-Way repeated measures Anova (GLMM) using time as random efect and by One-Way Anova using time as fxed efect. Mean arterial pressure was significant lower at skin closure compared to baseline in group R (p<0,001) and in group RD (p<0,001). Patients in group RD showed significant lower heart rate at dura matter incision, dura matter closure and skin closure compared to baseline, pin fixation and skin incision time points (p<0,001) and reported significantly less heart rate than group C (p<0,001) and group R (p<0,001) during dura matter incision, dura matter closure and skin closure time points. Patients in group RD receive significant lower fentanyl than group R (p<0,01). The intraoperative consumption of remifentanil was significant higher in control group compared to group R (p<0,01) and to group RD (p<0,001). Additionally, remifentanil consumption was significant lower in group RD as compared to group R (p<0,001). Postoperative pain had no statistically differences between the three groups at 24h and 48h after craniotomy (Preop VAS: p=0,915, VAS 24: p=0,284, VAS 48, p=0,385). No adverse effects were noted. Our study indicated that addition of dexmedetomidine to scalp block with ropivacaine 0.5% provided significantly better perioperative hemodynamic stability during elective craniotomy. Moreover, scalp block with or without dexmedetomidine reduced fentanyl and remifentanil consumption, but it didn't significantly prolonged analgesia in patients undergoing elective craniotomy.

Validity and Tolerability of Awake Calibration of an Accelerometer Neuromuscular Monitor.

Validity and Tolerability of Awake Calibration of an Accelerometer Neuromuscular Monitor.

Extremely prolonged neuromuscular blockade following a single dose of rocuronium in a dog

AbstractRocuronium is a non‐depolarising neuromuscular block drug extensively used in canine patients due to its favourable characteristics, including the fastest onset of action among all non‐depolarising neuromuscular blocking agents, lack of active metabolites and intermediate duration of effect. Although rocuronium elimination is relatively independent of kidney function, in the past few years, a growing number of reports describing a prolonged duration of the effect of rocuronium in human patients with renal failure have been published. However, to date, the mechanism behind this phenomenon is unclear. The present case describes the development of extremely prolonged neuromuscular blockade (&gt;5 hours) following a single dose of 0.5 mg/kg rocuronium in a female English bulldog with renal disease where neostigmine failed to provide adequate reversal, which was only subsequently achieved following administration of sugammadex. Aside from renal disease, other possible causes of this prolonged duration (relative drug overdose, hypoalbuminaemia, co‐administered drugs, neostigmine‐induced neuromuscular blockade and idiosyncratic reaction to rocuronium) are also discussed.

Impact of rocuronium on intraoperative neuromonitoring vagal amplitudes during thyroidectomy.

Neuromuscular blocking agents (NMBA) facilitate endotracheal intubation and reduce related laryngeal morbidity. However, NMBA interfere with intraoperative neuromonitoring amplitudes during thyroidectomy. The goal of this study was to evaluate the impact of rocuronium used for tracheal intubation on early intraoperative neuromonitoring vagal amplitudes observed during first thyroid lobe dissection. This is an observational pharmacoepidemiological study with prospective data collection and retrospective analysis. During the study period, all consecutive patients who underwent thyroid surgery with neuromonitoring were included. Patients underwent endotracheal intubation either using a single dose of rocuronium (NMBA group) or without NMBA (NMBA-free group) according to the anesthesiologist's preference. Six hundred six patients were included (213 NMBA and393 NMBA-free group patients). At V1, 39 patients (18%) in the NMBA group had an amplitude < 100µV (need for curarization reversal in 30 patients) and 13 patients (3.3%) in the NMBA-free group (p < 0.001). In the remaining 554 patients, the mean V1 amplitude was significantly decreased in the NMBA group (544 versus 685µV; p < 0.001). After exclusion of 25 patients with loss of signal types 1 and 2 during dissection, the difference between mean V1 and mean V2 was significantly lower in NMBA group patients (- 22 versus - 86µV; p = 0.016). This study provides new data showing how NMBA used for tracheal intubation significantly decrease V1 amplitude baseline and modify amplitude variations from V1 to V2 values during the first thyroid lobe dissection. Pharmacoepidemiological study.

Enhancement of muscle relaxant effect of rocuronium by intraseptal injection of a solution containing lidocaïne and epinephrine : a case report

Introduction : Various drugs and physiologic disturbances affect the action of neuromuscular blocking agents. If some are ignored by the anesthesiologist, e.g. in the absence of monitoring of neuromuscular function, the patient may be at risk of potentially severe consequences related to postoperative residual curarization. Case presentation : A 67-year-old female patient underwent septoplasty under general anesthesia with basic monitoring (three-lead electrocardiogram, non-invasive blood pressure, end-tidal partial pressure of carbon dioxide and SpO2) and a monitoring of neuromuscular function using acceleromyography of the adductor pollicis. General anesthesia was induced with propofol and sufentanil. After neuromuscular monitoring calibration, a single dose of rocuronium was given. Thereafter the trachea was intubated and anesthesia was maintained with sevoflurane. One hundred and two minutes after the administration of rocuronium, a 1% lidocaine solution containing 5µg/mL epinephrine was injected under the mucosa of the nasal septum immediately before the incision. Two minutes after this injection, the train of four ratio was significantly reduced. It took about 13 minutes to recover to the value recorded before the submucosal injection. Conclusion : Epinephrine increases the degree of muscle relaxation achieved by rocuronium, even when neuro-muscular function is recovering. Monitoring is the only mean to rule out a risk of postoperative residual curarization, given the numerous medications and factors interfering with the action of neuromuscular blocking agents.

The effect of prior tetanic stimulation on train-of-four monitoring in paediatric patients

In clinical research, neuromuscular monitoring must present a stable response for a period of 2 to 5 min before administration of a neuromuscular blocking agent. The time required to reach this stable response may be shortened by applying a 5-s tetanic stimulus. The aim of this study was to test whether tetanic stimulation interferes with onset and recovery times after a single dose of rocuronium 0.6 mg kg followed by spontaneous recovery. A randomised, open-label, controlled trial. A single-centre trial, study period from January 2014 to July 2015. Fifty children aged 2 to 11 years scheduled for elective paediatric surgery. Patients were randomly allocated to receive either tetanic stimulation (group T) or not (group C) before calibration of the neuromuscular monitor. Onset and recovery times. Initial and final T1 height, time to obtain initial T1 height stability and monitor settings were also analysed. There was no significant difference in mean onset time [(C: 57.5 (± 16.9) vs. T: 58.3 (± 31.2) s; P = 0.917]. Mean times to normalised train-of-four (TOF) ratios of 0.7, 0.8 and 0.9 were significantly shorter in the tetanic stimulation group [C: 40.1 (±7.9) vs. T: 34.8 (±10) min; P = 0.047, C: 43.8 (±9.4) vs. T: 37.4 (±11) min; P = 0.045 and C: 49.9 (±12.2) vs. T: 41.7 (±13.1) min; P = 0.026, respectively]. The mean time required for T1 height stabilisation was similar in the two groups [C: 195.0 (± 203.0) vs. T: 116.0 (± 81.6) s; P = 0.093], but the initial and final T1 height values were significantly lower in the tetanic stimulation group (C: 98.0 vs. T: 82.7%; P < 0.001 and C: 95.3 vs. T: 69.3%; P < 0.001, respectively). Tetanic stimulation shortened the mean times to normalised TOF ratios of 0.7, 0.8 and 0.9, but there was no difference in the mean onset time or the mean time required for T1 height stabilisation after a single dose of rocuronium 0.6 mg kg followed by spontaneous recovery in children aged 2 to 11 years. Clinicaltrials.gov. identifier: NCT02498678.

Bloc résiduel prolongé après injection unique de rocuronium pour l’intubation : une étiologie originale

Postoperative curarization following a single dose of rocuronium is a known risk quickly diagnosed through the monitoring of neuromuscular blockade. Different etiologies can cause a prolonged block. We report the case of a misdiagnosis of prolonged neuromuscular blockade by a failure in the monitoring system of curarization.

Bloc neuromusculaire extrêmement prolongé après une dose unique de rocuronium

Postoperative curarization in patients has been established. Nevertheless, extremely prolonged neuromuscular blockades are rare. We report the case of a prolonged neuromuscular blockade (lasting 10 hours) following a single dose of rocuronium, in an elderly patient with severe renal failure. We have studied the possible causes of prolonged curarization, and discussed the interest of the use of sugammadex in such cases.

Effects of residual paralysis after a single intubating dose of rocuronium on postoperative pulmonary function of patients undergoing laparoscopic gynecological surgeries

To evaluate the residual paralysis after a single intubating dose of rocuronium and its effect of residual paralysis after a single dose of rocuronium on the postoperative pulmonary function of patients undergoing laparoscopic gynecological surgeries. Sixty American Society of Anesthesiologists (ASA) I - II patients undergoing laparoscopic gynecological surgeries were randomly divided into rocuronium (R) group (n = 30) and rocuronium + neostigmine (R + N) group (n = 30).All patients received midazolam (0.02 mg/kg), fentanyl (1 microg/kg), propofol(1.5-2 mg/kg), and rocuronium (0.6 mg/kg) to facilitate tracheal intubation and no more relaxant thereafter. Anesthesia was maintained with isoflurane and nitrous oxide in oxygen (N(2)O:O(2) = 1:1). At the end of the procedure, neuromuscular blockade was not reversed in R group, while antagonism was accomplished with neostigmine (0.04 mg/kg) and atropine (0.02 mg/kg) in R + N group. Immediately after tracheal extubation and on arrival in the PACU, the train-of-four (TOF) ratio at the adductor pollicis of all patients were measured using acceleromyography. Forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), and peak expiratory flow rate (PEFR) of all patients were measured using spirometry before surgery, after administration of midazolam and fentanyl, immediately after tracheal extubation, on arrival in the PACU, and after the TOF ratio recovered to 1.0. The TOF ratio and pulmonary function between two groups were compared. Immediately after tracheal extubation and on arrival in the PACU, the mean TOF ratio in R group was significantly lower than that in R + N group (P < 0.05). The mean time to achieve TOF ratio of 0.9 and 1.0 in R group was significantly longer than in R + N group (P < 0.05). Immediately after tracheal extubation and on arrival in the PACU, FVC, FEV(1), and PEFR were significantly lower in R group than in R + N group (P < 0.05). FVC, FEV(1), and PEFR after administration of midazolam and fentanyl and after TOF ratio recovered to 1.0 were significantly lower than the baseline values in all patients (P < 0.01). After a single intubating dose of rocuronium, residual paralysis exists in the majority of patients undergoing laparoscopic gynecological surgeries. The pulmonary function is impaired after the surgery, even after recovery of TOF ratio to 1.0.

Neuromuskuläre Wirkzeiten von Rocuronium am Diaphragma, Musculus adductor pollicis und orbicularis oculi in zwei Altersgruppen

Onset time and recovery from non depolarising neuromuscular blockade depends on the tested muscle and is influenced by the age of the patient. This study compares the neuromuscular blocking effect of rocuronium on the diaphragm, adductor pollicis and orbicularis oculi muscle in young and elderly patients. After institutional ethics committee approval and written informed consent, 20 adult patients (ASA I - II), age 18 - 59 and > 65, have been included. Neuromuscular response was measured by accelerography for the adductor pollicis and orbicularis oculi muscle. Monitoring of the diaphragm consisted of measurement of the airway pressure against an occluded tracheal tube during magnetic phrenic nerve stimulation. Onset time and recovery were measured after injection of 0.6 mg/kg Rocuronium. The adductor pollicis had the fastest onset time ( young 2.3 min, old 2.2 min), followed by diaphragm ( young 3.6 min, old 3.4 min) and orbicularis oculi muscle ( young 3.7 min, old 4.8 min). There was a complete blockade of the diaphragm in 50 % of all patients (Adductor pollicis 100 %, orbicularis oculi 40 %). Neuromuscular recovery, recovery index and TOF 0.8 differed significantly between young and elderly patients. Onset of recovery was earlier at the diaphragm ( young 15.9 min, old 22.0 min) compared to the peripheral muscles (adductor pollicis young 25.6 min, old 37.9 min, orbicularis oculi young 23.8 min, old 27.5 min). 2 fould ED95 of rocuronium often results in an incomplete neuromuscular blockade of the diaphragm. Therefore monitoring of the peripheral muscles in patients given a single dose of rocuronium often overestimates the degree of diaphragmatic relaxation, but is a save predictor of recovery. Especially in elderly patients were prolonged neuromuscular blockade should be expected, a neuromuscular monitoring is recommended.

Dose‐response relationship of rocuronium: A comparison of electromyographic vs. acceleromyographic‐derived values

Acceleromyography (AMG) is being employed with increasing frequency as a research tool. However, there is almost no information available regarding the accuracy of values for drug potency obtained using AMG. This study was an attempt to determine if AMG-derived ED(50/95) values are interchangeable with those measured with a more traditional neuromuscular monitor. Thirty adult patients were studied. Anesthesia was induced and maintained with N20, propofol, and supplementation opioid. Tracheal intubation was accomplished without muscle relaxants. Simultaneous ipsilateral AMG and EMG responses to 0.10 Hz stimulation was recorded. Following instrument calibrations, a single dose of rocuronium was administered. The first patient received a bolus of 0.17 mg kg(-1) of rocuronium. Using the Hill equation with a postulated slope of 4.50, the ED(50) was calculated. The second subject received a dose which approximated the calculated ED(50) for patient no. 1. Successive subjects were given a dose based on the running average of the estimated ED(50). The AMG-derived ED50/95 values for rocuronium (0.163 +/- 0.055 and 0.314 +/- 0.105 mg mg(-1)) were virtually identical to those established using EMG (0.159 +/- 0.043 and 0.306 +/- 0.084 mg kg(-1)). While mean peak twitch depression (Delta T1) was the same in both groups for individual subjects Delta T1 differed by +/- 20% (95% confidence interval). Acceleromyography-derived twitch heights for individual patients are not necessarily interchangeable with information obtained using electromyography. Nevertheless, acceleromyography appears to be a valid methodology for determining the drug potency when a population rather than an individual subject is being studied.

Reversal of rocuronium with edrophonium during propofol versus sevoflurane anesthesia

The use of volatile anesthetics for maintenance of anesthesia can enhance the action of non-depolarizing muscle relaxants and interfere with the reversal of neuromuscular blockade. In this study, we studied the antagonism of rocuronium with edrophonium-atropine during propofol- versus sevoflurane-based anesthesia. Following induction of anesthesia with propofol (2-2.5 mg kg(-1), i.v.) and fentanyl (1-2 microg kg(-1) i.v.), rocuronium 0.6 mg kg(-1) i.v. was administered to facilitate tracheal intubation. Patients were then randomized to receive either a propofol infusion (100 microg kg(-1) min(-1)) or sevoflurane (1.0%, end-tidal) in combination with nitrous oxide 66% for maintenance of anesthesia. Neuromuscular blockade was monitored using electromyography at the wrist, and reversed with edrophonium 1.0 mg kg(-1) and atropine 0.015 mg kg(-1) when the first twitch hight (T1) of the train-of-four (TOF) stimulation recovered to 25% of the baseline value. Anesthetic maintenance with propofol or sevoflurane was continued following reversal until a TOF ratio of 0.7 was attained. The clinical duration of action (i.e., time to 25% T1 recovery) was similar during both propofol- (39.3+/-14.6 min) and sevoflurane-based (48.1+/-19.7 min) anesthesia. However, the reversal time from 25% T1 to TOF ratio of 0.7 was significantly longer with sevoflurane [Median 2.8 (range 0.5-18.8) min] compared with propofol [1.5 (0.75-3) min] (P<0.05). We conclude that the clinical duration of action after a single dose of rocuronium, 0.6 mg kg(-1) i.v., was similar during both propofol- and sevoflurane-based anesthesia. However, the reversal of rocuronium-induced residual blockade was slower and more variable in the presence of sevoflurane.

Pharmacodynamics of Rocuronium With and Without Prior Administration of Succinylcholine

Comment Carefully controlled clinical trials are needed to establish the pharmacokinetic and pharmacodynamic behavior of new drugs to define dosing guidelines for routine use and to permit comparisons with other drugs, thereby enabling clinicians to properly “place” the new agent in their arsenal. This investigation appears to be a straightforward characterization of the kinetics of onset and offset of neuromuscular blockade with a single dose of rocuronium and in comparison with a single dose of succinylcholine. Succinylcholine clearly had a faster onset, and rocuronium had onset times typical of nondepo-larizing blockers, but the times for both drugs provided adequate intubating conditions. Importantly, the duration of rocuronium blockade was not increased by prior succinylcholine administration, and there was no evidence of cumulation. More careful reading of this paper, however, reveals a paradox: intubating times were unrelated to the onset of neuromuscular blockade. Ulnar nerve stimulation and thumb adduction force monitoring were used. The investigator/intubator was blinded and not in the operating room at the time of drug administration. When the first twitch of the train-of-four reached 80% depression (T180) the investigator was called to the operating room to perform the intubation. Times to T180 were 41 ± 15 and 70 ± 24 sec for succinylcholine and rocuronium, respectively. Times to completion of intubation were 76 ± 29 and 85 ± 23 sec for succinylcholine and rocuronium, respectively. We are faced with major questions. Why, despite significantly longer T180 times for rocuronium, was the time for completion of intubation the same? Why did it take the intubator an average of 35 sec to intubate after succinylcholine but only an average of 15 sec after rocuronium? The investigators offer some possible explanations. They state that “most succinylcholine patients felt ”tighter“ during laryngoscopy.” However, this is not supported by the data on intubation scores, which were the same in