scholarly journals Comparison between single-dose suxamethonium and rocuronium after pretreatment with dexmedetomidine in rapid sequence induction

2022 ◽  
Vol 14 (1) ◽  
Author(s):  
Ossama Hamdy Salman
Keyword(s):  
Adverse Events ◽  
Confidence Interval ◽  
Rapid Sequence Induction ◽  
Link Type ◽  
Intubating Conditions ◽  
Rapid Sequence ◽  
Gastric Aspiration ◽  
Number Of Patients ◽  
Significant Difference ◽  
Sequence Induction

Abstract Background Rapid sequence induction is a well-established anesthetic procedure used in patients with a high risk of gastric aspiration. Suxamethonium has been the drug of choice; however, it carries potential risks and sometimes fatal outcomes. The aim of our study was to compare rocuronium after pretreatment with dexmedetomidine, to suxamethonium in providing excellent intubating conditions in rapid sequence induction in adults. Patients were randomly allocated to one of two groups, of 120 each. Control group (SS), patients received pretreatment with 10 ml 0.9% saline over 10 min and suxamethonium 1mg/kg. Experimental group (DR), received pretreatment with dexmedetomidine 1 μg/kg in 10 ml 0.9% saline over 10 min and rocuronium 0.6 mg/kg. Our primary endpoint was the number of patients who scored “excellent” on intubation conditions score, while secondary outcomes were hemodynamics and adverse events. Results The rate of excellent intubating conditions in the DR group 46% was insignificantly less (P value = 0.548) than that of the SS group 49% (relative risk (RR) of DR compared to SS = 1.04, with a confidence interval (CI) of 0.91–1.48. The percentage of patients with adverse events in the SS group was (30%) nearly more than twofold higher than that of the DR group (11%). A significant difference (P value = 0.016) in the incidence of excellent intubating conditions was higher in the female gender 59% compared to the male gender 38% (adjusted RR = 0.98, with a confidence interval of 0.79–1.1). Conclusion A combination of dexmedetomidine 1μg/kg and standard intubating dose of rocuronium 0.6 mg/kg provided comparable endotracheal intubation conditions to suxamethonium 1 mg/kg during RSI and might be used as an alternative to suxamethonium in situations where suxamethonium is contraindicated. Trial registration ClinicalTrials.gov Identifier: NCT04709315

scholarly journals Rapid sequence induction: where did the consensus go?

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Pascale Avery ◽  
Sarah Morton ◽  
James Raitt ◽  
Hans Morten Lossius ◽  
David Lockey
Keyword(s):  
Cricoid Pressure ◽  
Rapid Sequence Induction ◽  
Hospital Environment ◽  
Training Technique ◽  
Rapid Sequence ◽  
Gastric Aspiration ◽  
Sequence Induction ◽  
The Uk ◽  
Key Aspects ◽  
Risk Of Aspiration

Abstract Background Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.

The comparison of the incidence of postoperative Sore Throat, Hoarseness and Myalgia between rocuronium and succinylcholine for RSII: a randomized controlled trial

2019 ◽  
Author(s):  
Jie Wang ◽  
Fang Du ◽  
Jing Cang ◽  
Chao Liang ◽  
Zhanggang Xue
Keyword(s):  
Sore Throat ◽  
Controlled Trial ◽  
Rapid Sequence Induction ◽  
Postoperative Sore Throat ◽  
Randomized Controlled ◽  
Intubating Conditions ◽  
Rapid Sequence ◽  
High Incidence ◽  
Sequence Induction ◽  
Registration Date

Abstract Background: The present study was designed to compare the incidence of postoperative sore throat, hoarseness, and myalgia between rocuronium and succinylcholine for rapid sequence induction and intubation. Methods: One hundred and twenty-four patients were randomly divided into rocuroniun group (group R, n=62) or succinylcholine group (group S, n=62). Anesthesia was induced with propofol 2mg kg-1 and remifentanil 2μg kg-1in both groups, and then rocuronium 0.6 mg kg-1 or succinylcholine 1.5mg kg-1 was given after patient lost consciousness. Tracheal intubation was performed 60s after these two muscle relaxants were given and the intubating conditions were evaluated. The incidences of postoperative sore throat, hoarseness and myalgia were evaluated at postoperative care unit(PACU), 12hours 24hours and 48hours postoperatively. Results: The numbers of patients with excellent and good intubating conditions in group R were 90.0% and 6.7%, respectively, which were comparable with those in group S (91.7% and 5.0% respectively). The incidence of postoperative sore throat of group S (41.8%) was significantly higher than that of group R (18.3%) in PACU (P<0.05), at 12 hours (38% versus 10%, P<0.05) and 24 hours postoperatively (32% versus 6.7%, P<0.05), however, these differences reached an insignificant level at 48 hours postoperatively (3.3% versus 1.7%). There were some cases in both groups underwent hoarseness and/or myalgia at each time point, but the differences did not reach a significant level. Conclusions: In the context of a RSII with lidocaine–remifentanil–propofol, compared with rocuronium, succinylcholine supplementation was associated with high incidence of postoperative sore throat. Trial registration: The present study was prospectively registered at http://www.chictr. org/cn/(ChiCTR-IOR-15006977); Registration date: Nov 4, 2015 Keywords: Rocuronium, Succinylcholine, Sore Throat, Hoarseness, Myalgia

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