Background: A Double blind Randomized Control Trial was done to compare Rocuronium and Succinylcholine for endotracheal intubation for elective surgeries in adult patients done under general anesthesia.

Materials & Methods: 80 patients were divided into 2 groups of 40 each. Group A received Rocuronium at 0.9 mg/kg and Group B received Succinylcholine at 2mg/kg dose.

Statistical Analysis used: The statistical difference in the age, weight, height of the study subjects, onset of action of relaxant, intubation conditions, time taken to intubate, and duration of action were compared using analysis of variance and unpaired t-test.

Results: Comparison between Rocuronium at 0.9mg/kg and Succinylcholine at 2mg/kg for elective endotracheal intubation revealed that the onset time, time taken to intubate and the duration of action was significantly higher in the Rocuronium group. However the intubation conditions were found to be comparable and without statistical difference between the two groups

Conclusion: In the setting of a rapid sequence induction of anesthesia where succinylcholine may be contraindicated, Rocuronium at a dose of 0.9mg/kg is found to produce comparable intubation conditions and thus may be used as a suitable alternative in such situations.

Keywords: Anesthesia-general, neuromuscular blockade, intubating time, rocuronium, succinylcholine.

1. Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review Anaesthesia Journal of the Association of Anaesthetists of Great Britain and Ireland D. T. T. Tran, E. K. Newton, V. A. H. Mount, J. S. Lee, C. Mansour, G. A. Wells, J. J. Perry
2. Rosenblatt WH. Airway Management. In: Barash PG, Cullen BF, Stoelting RK, eds. Clinical Anesthesia, 4thPhiladel-phia: Lippincott Williams & Wilkins,  2001: 610.
3. Marsch SC, Steiner L, Bucher E, Pargger H, Schumann M, Aebi T, et al. Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: A prospective, randomized controlled trial. Crit Care 2011;15:R199.
4. Sluga M, Ummenhofer W, Studer W, Siegemund M, Marsch SC. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: A prospective, randomized trial in emergent cases. Anesth Analg 2005;101:1356-61.
5. Tryba M, Zorn A, Thole H, Zenz M. Rapid-sequence orotracheal intubation with rocuronium: A randomized double-blind comparison with suxamethonium — preliminary communication. Eur J Anesthesiol Suppl 1994;9:44-8.
6. Crul JF, Vanbelleghem V, Buyse L, Heylen R, van Egmond J. Rocuronium with alfentanil and propofol allows intubation within 45 seconds. Eur J Anesthesiol Suppl 1995;11:111-2.
7. Minton MD, Grosslight K, Stirt JA, Bedford RF. Increases in intracranial pressure from succinylcholine: prevention by prior nondepolarizing blockade.  Anesthesiology1986; 65: 165–9.
8. Vinik HR. Intraocular pressure changes during rapid sequence induction and intubation: a comparison of rocuronium, atracurium, and succinylcholine. Journal of Clinical Anesthesia1999; 11: 95–100.
9. Combs JM, Combs GN. A literature review of the newest muscle relaxant: org 9426. The Clinical Forum for Nurse Anesthetists1994; 5: 104–12.
10. Schreiber JU, Lysakowski C, Fuchs-Buder T, Tramer MR. Prevention of succinylcholine-induced fasciculation and myalgia: a meta-analysis of randomized trials. Anesthesiology2005; 103: 877–84.
11. Magorian T, Flannery KB, Miller RM. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology1993; 79: 913–8.
12. Soto R, Jahr JS, Pavlin J, et al. Safety and efficacy of rocuronium with sugammadex reversal vs. succinylcholine in outpatient surgery–a multicenter, randomized, safety assessor-blinded trial. American Journal of Therapeutics2015; 23: 1654–62.
13. Chavan SG, Gangadharan S, Gopakumar AK; Comparison of rocuronium at two different doses and succinylcholine for endotracheal intubation in adult patients for elective surgeries; Saudi Journal of Anesthesia 2016 Oct-Dec;10(4):379-383
14. Vinik HR. Intraocular pressure changes during rapid sequence induction and intubation: a comparison of rocuronium, atracurium, and succinylcholine. Journal of Clinical Anesthesia1999; 11: 95–100.
15. Schaller SJ, Fink H. Sugammadex as a reversal agent for neuromuscular block: an evidence-based review. Core Evid. 2013;8:57-67.
16. Welliver M, McDonough J, Kalynych N, Redfern R. Discovery, development, and clinical application of sugammadex sodium, a selective relaxant binding agent. Drug Des Devel Ther. 2009;2:49-59.
17. Tran DT, Newton EK, Mount VA, Lee JS, Wells GA, Perry JJ. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2015;10:CD002788.

Dr Letha J