Title: Comparison of Rocuronium in Two Different Doses with Succinyl Choline – Onset Time, Duration of Action and Intubating Conditions
Author: Sheeba franklin
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.138
Abstract
Background: Rocuronium Bromide is an ewer, low potency non-depolarising neuromuscular blocking agent. Patients often require an endotracheal intubation technique during emergencies or electively to protect against aspiration, increased intracranial pressure, or to facilitate intubation. Traditionally succinylcholine has been the most commonly used muscle relaxant for this purpose because of its fast onset and short duration; unfortunately, it can have serious side effects. Rocuronium has been suggested as an alternative to succinylcholine for intubation The aim of this study was to compare tracheal intubating conditions, onset time, duration of action of rocuronium 0.9 mg/kg, 0.6 mg/kg and succinylcholine 1.5 mg/kg during induction of anaesthesia.
Methods and findings: This prospective, randomized, double – blind study was carried out in seventy- five ASA grade (I – II) adults, aged 18-65 years of either sex, who were scheduled to undergo various surgeries under general anaesthesia. Patients were divided into three groups. Group I received succinyl choline 1.5 mg/kg intravenously (n=25), Group II received rocuronium0.6mg/kg intravenously (n=25), Group III received rocuronium 0.9 mg/kg intravenously (n=25) after induction with propofol. Intubation was attempted on fading of all four twitches of adductor pollicis muscle, evoked after train of four stimulation of ulnar nerve using a peripheral nerve stimulator at every 15 seconds after injection of muscle relaxant. Onset time, duration of action and intubating conditions were assessed.
Results: Excellent intubating conditions were obtained in 84 %, 56 % and84 % of the patients after administration of succinyl choline 1.5 mg/kg, rocuronium 0.6 mg/kg and rocuronium 0.9 mg/kg respectively; P 0.032. Acceptable intubating conditions (excellent and good grade combined) were obtained in all patients. Onset time and duration of action were significantly more in rocuronium group 0.9 mg/kg (111.00±19.3 sec and 45.60±6.87 min respectively) as compared to rocuronium 0.6 mg/kg (195.72±34.62 sec and 27.04±6.79 min respectively) while succinyl choline group (64.92±10.91 sec and 8.64±2.23 min respectively).
Conclusion: Rocuronium has anintermediate duration of action. Onsettime of rocuronium is reduced with increase in dose from 0.6 mg/kg to 0.9 mg/kg. Rocuronium provides clinically acceptable intubating conditions comparable to that of succinyl choline.
Keywords: Anaesthesia, intubating conditions, rapid sequence induction, succinylcholine, rocuronium.
References
1. Jeevendra Martyn J.A., Frank G Standeart, Ronald D Miller, Neuromuscular physiology and Pharmacology, Aneshesia- 5th Edition. Ronald D. Miller
2. C.L.Chiu, F.Jaais and C.Y.Wang-Effect of rocuronium compared withsuccinyl choline on intraocular pressure during Rapid Sequence Inductionof Anaesthesia. Br J Anaesth l999 ; 82 :757-60
3. B.KohlSchutter, H.Baur and F.Roth. Suxamethonium - Induced hyperKalemia in patients with severe intraabdominal infections . Br J Anaesth1976 ;48 : 557-562
4. Robert.K. Stoelting. Pharmacolory and physiology in Anaesthesia practiceed : 3rd
5. Naguib M, Samarkandi A, Riad W, Alharby SW. Optimal dose of succinyl-choline revisited. Anesthesiology 2003;99: 1045-9.
6. PollardB J, ChettyM S Wilson et al. Intubation conditions and time course of action of low dose rocuronium Bromide in day Care dental surgery Eur J Anaesth 1995, 12(11): 81-83
7. MAGORIAN T, Flannery K.B. MillerRD Comparison of rocuronium, Succinyl choline and vecuronium for rapid sequence induction of anesthesia in adult patients. Anesthesiology 1993: 79: 913-918
8. C. Baillard, A.M.Korinek, V.Galanton Anaphylaxis to rocuronium. Br JAnaesth 2002;88 : 600-602
9. MagoriumT; Wood P,Cald well J et al. The Pharmaco Kinetic and neuromuscular effects of rocuronium Bromide in patients with liver disease. Anesth Analg. 1995 ; 80 : 754-759
10. M C Court K C, Salmela L,Mirakhur R K et al. Comparison ofrocuronium and suxamethonium for use during rapid sequence Induction ofanaesthesia. Anesthesia 1998 ;53 :867-871
11. De Mey J C, De Brock M, Rolly G et al. Evaluation of onset andintubation conditions of rocuronium Bromide. Eur J Anaesth 1994 ; I 1(9) :37-40
12. Cooper R;Mirakhur R K, Clarke R S et al. Comparison of intubating conditions after administration of org 9426 (rocuronium) and Suxamethonium. Br J Anaesth 1992;69:269-273.
13. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39:1105-11.
14. Land I,StovnerJ, Experimental and clinical experiences with a neuromuscular relaxant R05 -3816,diallyl nor – toxiferine .ActaAnaesthesiolScand1962; 6: 85-97.
15. Sparr H T,Lugger T J, Heidegger T et al Comparison of intubating conditions after rocuronium and suxamethonium following rapid sequence induction with thiopentone in elective cases. Acta Anaesthesiol Scand, 1996;40: 425-430.
16. Cooper R ; Mirakhur R K , Clarke R S et al , Comparison of intubating conditions after administration org 9426 (rocuronium) and suxamethonium , Br J Anaesth 1992 ; 69: 269-273 .
17. A comparative study of effect of sevoflurane on intubating conditions with rocuronium in neurosurgical patients. Saikat Mitra, Shobha Purohit, Sonali Bhatia, Poonam Kalra, Satya Prakash Sharma. Indian Journal of Anaesthesia, Year 2015, Volume 59, Issue 12 [p. 774-778].
18. A comparative study of rocuronium, vecuronium and succinylcholine for rapid sequence induction of anaesthesia. MN Misra, M Agarwal, RP Pandey, A Gupta Indian Journal of Anaesthesia, Year 2005, Volume 49, Issue 6 [p. 469].