Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-24T07:26:27.275Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparative study of intubating conditions at the first minute with suxamethonium, rocuronium and different priming techniques of rocuronium

Published online by Cambridge University Press:  29 April 2005

J. R. Ortiz-Gómez ,
F. Carrascosa ,
J. J. Pérez-Cajaraville ,
J. A. Percaz-Bados  and
C. Añez
J. R. Ortiz-Gómez
Affiliation:
University Clinic, Department of Anesthesiology and Intensive Care, Tarragona, Spain University of Navarra, School of Medicine, Department of Anesthesiology, Navarra, Spain Royal Academy of Medicine and Surgery of Valladolid, Valladolid, Spain
F. Carrascosa
Affiliation:
University Clinic, Department of Anesthesiology and Intensive Care, Tarragona, Spain University of Navarra, School of Medicine, Department of Anesthesiology, Navarra, Spain
J. J. Pérez-Cajaraville
Affiliation:
University Clinic, Department of Anesthesiology and Intensive Care, Tarragona, Spain
J. A. Percaz-Bados
Affiliation:
University Clinic, Department of Anesthesiology and Intensive Care, Tarragona, Spain
C. Añez
Affiliation:
Joan XXIII Hospital, Department of Anesthesiology, Tarragona, Spain
Get access

Abstract

Summary

Background and objective: To evaluate orotracheal intubation conditions after 1 min.

Patients and methods: A prospective randomized study with 376 adult American Society of Anesthesiologists (ASA) Grade I–III patients. Each patient received propofol, fentanyl and either suxamethonium (1 mg kg−1) or rocuronium. The intubating dose of rocuronium (2 × ED95) was preceded 4 min earlier by saline, or a 0.1 × ED95 priming dose of rocuronium, atracurium, cis-atracurium, vecuronium or mivacurium. Intubating conditions were graded as excellent, good or poor with respect to laryngoscopy, vocal cord position and movement and reaction to intubation and/or cuff inflation.

Results: There were significant differences (P < 0.05) in laryngoscopy between suxamethonium and rocuronium primed with saline, atracurium or cis-atracurium. With respect to vocal cord position and movement during intubation, rocuronium without priming differed significantly from all other groups and for reaction to insertion of tracheal tube and/or cuff inflation. Rocuronium without priming differed significantly from all other groups except for rocuronium primed with itself. The mivacurium group showed more signs of pre-curarization than other groups (P < 0.05). There were significant differences between rocuronium alone and the other groups when final intubating conditions were compared.

Conclusions: Priming rocuronium with 0.1 × ED95 of vecuronium, rocuronium, atracurium or cis-atracurium is a safe technique and did not increase risk of pre-curarization in healthy patients.

Keywords

ANAESTHETICS, INTRAVENOUS, propofolINTUBATION, INTRATRACHEALNEUROMUSCULAR NON-DEPOLARISING AGENTS, rocuronium, atracurium, vecuronium, cis-atracurium, mivacuriumNEUROMUSCULAR DEPOLARIZING AGENTS, succinylcholineNEUROMUSCULAR BLOCKADE, onset
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 4 , April 2005 , pp. 263 - 268
Copyright
2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Skinner HJ, Biswas A, Mahajan RP. Evaluation of intubating conditions with rocuronium and either propofol or etomidate for rapid sequence induction. Anaesthesia 1998; 53: 702–706.Google Scholar
Dobson AP, McCluskey A, Meakin G, Baker RD. Effective time to satisfactory intubating conditions after administration of rocuronium in adults. Comparison of propofol and thiopentone for rapid sequence induction of anaesthesia. Anaesthesia 1999; 54: 172–176.Google Scholar
Fuchs-Buder T, Sparr HJ, Ziegenfuss T. Thiopental or etomidate for rapid sequence induction with rocuronium. Br J Anaesth 1998; 80: 504–506.Google Scholar
Lavazais S, Debaene B. Choice of the hypnotic and the opioid for rapid-sequence induction. Eur J Anaesthesiol 2001; 18 (Suppl 23): 66–70.Google Scholar
Sparr HJ, Giesinger S, Ulmer H, Hollenstein-Zacke M, Luger TJ. Influence of induction technique on intubating conditions after rocuronium in adults: comparison with rapid-sequence induction using thiopentone and suxamethonium. Br J Anaesth 1996; 77: 339–342.Google Scholar
Wong AK, Teoh GS. Intubation without muscle relaxant: an alternative technique for rapid tracheal intubation. Anaesth Intens Care 1996; 24: 224–230.Google Scholar
Crul JF, Vanbelleghem V, Buyse L, Heylen R, van Egmond J. Rocuronium with alfentanil and propofol allows intubation within 45 seconds. Eur J Anaesthesiol 1995; 11 (Suppl): 111–112.Google Scholar
Feldman SA. Rocuronium-onset times and intubating conditions. Eur J Anaesthesiol 1994; 9: 49–52.Google Scholar
White PF. Rapacuronium: why did it fail as a replacement for succinylcholine? Br J Anaesth 2002; 88: 163–165.Google Scholar
Sieber TJ, Zbinden AM, Curatolo M, Shorten GD. Tracheal intubation with rocuronium using the ‘timing principle’. Anesth Analg 1998; 86: 1137–1140.Google Scholar
Viby-Mogensen J, Engbaek J, Eriksson LI, et al. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40: 59–74.Google Scholar
De Mey JC, De Baerdemaeker L, De Laat M, Rolly G. The onset of neuromuscular block at the masseter muscle as a predictor of optimal intubating conditions with rocuronium. Eur J Anaesthesiol 1999; 16: 387–389.Google Scholar
Plaud B, Debaene B, Donati F. The corrugator supercilii, not the orbicularis oculi, reflects rocuronium neuromuscular blockade at the laryngeal adductor muscles. Anesthesiology 2001; 95: 96–101.Google Scholar
Ortiz Gómez JR. Bloqueantes neuromusculares no despolarizantes: atracurio, cisatracurio, mivacurio, vecuronio y rocuronio. In: Anestesia total intravenosa. Principios básicos. Luciano Aguilera Celorrio. Ed Springer-Verlag Francia 2002. España2002; 101–122.
Duke PC, Johns CH, Pinsky C, Goertzen P. The effect of morphine on human neuromuscular transmission. Can Anaesth Soc J 1979; 26: 201–205.Google Scholar
Boros M, Chaudhry IA, Nagashima H, Duncalf RM, Sherman EH, Foldes FF. Myoneural effects of pethidine and droperidol. Br J Anaesth 1984; 56: 195–202.Google Scholar
Ortiz-Gomez JR. Efecto directo de los inductores anestésicos sobre el registro electromiográfico del adductor pollicis. Rev Esp Anestesiol Reanim 2000; 47: 157–161.Google Scholar
Dueck MH, Oberthuer A, Wedekind C, Paul M, Boerner U. Propofol impairs the central but not the peripheral part of the motor system. Anesth Analg 2003; 96: 449–455.Google Scholar
Tatsumi K, Hirai K, Fukushima T, Einaga T, Furuya H, Okuda T. The effect of priming dose of vecuronium on the diaphragm and the hypothenar. Masui 1994; 43: 374–377.Google Scholar
Shorten GD, Braude BM. Pulmonary aspiration of gastric contents after a priming dose of vecuronium. Paediatr Anaesth 1997; 7: 167–169.Google Scholar
Kopman AF, Khan NA, Neuman GG. Precurarization and priming: a theoretical analysis of safety and timing. Anesth Analg 2001; 93: 1236–1243.Google Scholar
Glass PS, Wilson W, Mace JA, Wagoner R. Is the priming principle both effective and safe? Anesth Analg 1989; 68: 127–134.Google Scholar
Mortier E, Versichelen L, Herregods L, Rolly G. Priming with vecuronium and atracurium – a comparison. Acta Anaesthesiol Belg 1987; 38: 83–87.Google Scholar
Sparr HJ. Choice of the muscle relaxant for rapid-sequence induction. Eur J Anaesthesiol 2001; 23 (Suppl): 71–76.Google Scholar
Naguib M. Different priming techniques, including mivacurium, accelerate the onset of rocuronium. Can J Anaesth 1994; 41: 902–907.Google Scholar
Aziz L, Jahangir SM, Choudhury SN, Rahman K, Ohta Y, Hirakawa M. The effect of priming with vecuronium and rocuronium on young and elderly patients. Anesth Analg 1997; 85: 663–666.Google Scholar
Griffith KE, Joshi GP, Whitman PF, Garg SA. Priming with rocuronium accelerates the onset of neuromuscular blockade. J Clin Anesth 1997; 9: 204–207.Google Scholar
Redai I, Feldman SA. Priming studies with rocuronium and vecuronium. Eur J Anaesthesiol 1995; 11 (Suppl): 11–13.Google Scholar
England AJ, Margarson MP, Feldman SA. Tracheal intubation conditions after one minute: rocuronium and vecuronium, alone and in combination. Anaesthesia 1997; 52: 336–340.Google Scholar
Naguib M. Different priming techniques, including mivacurium, accelerate the onset of rocuronium. Can J Anaesth 1994; 41: 902–907.Google Scholar