A randomized double blind comparative study on onset time and intubating conditions achieved with succinylcholine 1.5mg/kg and Rocuronium 0.6mg/kg & 0.9mg/kg IV

A perfect setting for tracheal intubation include a rapid onset, and short duration of action. These requirements are best met by succinylcholine, an ultrashort acting depolarizing muscle relaxant. However its many unwanted side effects have necessitated a search for an alternative drug. Rocuronium bromide is a steroid, non-depolarizing neuromuscular blocking agent with a rapid onset and an intermediate duration of action. It may be a suitable alternative to succinylcholine.

To study and compare the efficacy of rocuronium bromide in two dosage schedules-0.6mg/kg (2 x ED95) and 0.9mg/kg (3 x ED95) IV, with succinylcholine chloride 1.5mg/kg IV in patients with respect to:

Intubating conditions at one minute

Onset of action

Adverse effects

This study was conducted at Government Stanley Hospital, Chennai, in the patients undergoing general surgical procedures. After institutional approval and informed consent, 60 patients were enrolled in the study.

Group A: Succinylcholine 1.5 mg/kg (Sch 1.5)

Group B: Rocuronium bromide 0.6 mg/kg (2 x ED 95)(Roc 0.6)

Group C: Rocuronium bromide 0.9 mg/kg (3 x ED 95)(Roc 0.9)

Anaesthesia was induced with Thiopentone sodium 5mg/kg over a period of 20 seconds. The ulnar nerve was stimulated at the wrist using 0.1 Hz single twitch stimulation mode and the supramaximal current was determined. Once a control twitch height was established the bolus of randomly assigned neuromuscular blocking agent was administered intravenously in less than 5 seconds. When injection was completed, a timer was started and after 20 seconds the ulnar nerve was stimulated using single twitch mode at a frequency of 1 Hz. At one minute, intubation was performed and scored by a blinded experienced anaesthesiologist. anaesthesia was maintained with Nitrous oxide, oxygen and Neuromuscular blocking agents.

Vocal cord relaxation is comparable between group a and c. Excellent intubating conditions was seen with Group A (Sch 1.5mg/kg) with 100% score. Excellent intubating conditions with Group B (Roc 0.6 mg/kg) and Group C are 30% and 85% respectively. P value of Succinylcholine 1.5 mg/kg and Rocuronium 0.9 mg/kg is 0.466 statistically not significant.

Succinylcholine is an ideal agent for intubation in all surgical procedures. Intubating conditions of Rocuronium bromide at a dose of 0.9mg/kg (3xED95) is comparable to Succinylcholine 1.5mg/kg at 1minute. Rocuronium bromide 0.9 mg/kg can be used safely in patients where Succinylcholine is contraindicated.