Rocuronium for intubation in parturients undergoing caesarean section

Background: Anaesthetic management of a parturient is a challenge because it involves simultaneous care of both mother and baby. Succinylcholine, a depolarizing muscle relaxant is most commonly used and considered “The Gold Standard’’ for tracheal intubation. Among currently available non-depolarizing neuromuscular blocking agent rocuronium bromide is the only agent that has rapid onset of action which is comparable to succinylcholine. Thus, rocuronium may provide alternative to succinylcholine for rapid sequence induction of anaesthesia wherever succinylcholine is contraindicated.Methods: In a control trial, 60 parturients of ASA grade I and II were randomly allocated in two groups of 30 patients each (group R and group S). After preoxygenation for a period of 5minutes rapid sequence induction done with thiopentone 5mg/kg for all patients. Muscle relaxant rocuronium (0.6mg/kg) was administered for group R. Succinylcholine was given in similar dosage (0.6mg/kg) for group S. The intubation was tried after 90 seconds in group R (rocuronium group) but after 60 seconds in group S (succinylcholie group). The intubating conditions were assessed and compared among the groups using criteria suggested by Cooper et al.Results: The mean intubation time was 98.3 seconds in group R and 67.9 seconds in group S. Rocuronium produced clinically acceptable intubating conditions in 28 out 30 patients (93.33%). Among these 28 patients 70% had excellent intubating conditions and 23.33% had good intubating conditions. Clinically acceptable intubating conditions were present in all 30 patients (100%-90% excellent and 10% good) who were administered succinylcholine. Succinylcholine produced excellent intubating conditions at 60 seconds (90 percent) compared to rocuronium (70 percent). However, this difference was statistically insignificant (p= 0.053). The mean Apgar score at 1 min and 5 min in group R was 8.1 and 8.83 as against 8.06 and 8.96 in babies born to mother in group S.Conclusions: Rocuronium (0.6mg/kg) provided acceptable intubation conditions after a waiting period of 90 seconds in 93.33% patients as against 100% patients in succinylcholine administered patients in equivalent dosage. So rocuronium is a promising alternative for rapid sequence induction in parturients in whom succinylcholine is not advisable or contraindicated.

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Rocuronium Versus Suxamethonium: A Survey of First-line Muscle Relaxant Use in UK Prehospital Rapid Sequence Induction

Prehospital and Disaster Medicine ◽

10.1017/s1049023x15000047 ◽

2015 ◽

Vol 30 (2) ◽

pp. 184-186 ◽

Cited By ~ 6

Author(s):

Emma L. Hartley ◽

Roger Alcock

Keyword(s):

Muscle Relaxant ◽

Online Survey ◽

Muscle Relaxation ◽

Rapid Sequence Induction ◽

First Line ◽

Publication Type ◽

Intubating Conditions ◽

Rapid Sequence ◽

Sequence Induction ◽

The Uk

AbstractIntroductionPrehospital anaesthesia in the United Kingdom (UK) is provided by Helicopter Emergency Medical Service (HEMS) and British Association for Immediate Care (BASICS), a road-based service. Muscle relaxation in rapid sequence induction (RSI) has been traditionally undertaken with the use of suxamethonium; however, rocuronium at higher doses has comparable intubating conditions with fewer side effects.Hypothesis/ProblemThe aim of this survey was to establish how many prehospital services in the UK are now using rocuronium as first line in RSI.MethodsAn online survey was constructed identifying choice of first-line muscle relaxant for RSI and emailed to lead clinicians for BASICS and HEMS services across the UK. If rocuronium was used, further questions regarding optimal dose, sugammadex, contraindications, and difference in intubating conditions were asked.ResultsA total of 29 full responses (93.5%) were obtained from 31 services contacted. Suxamethonium was used first line by 17 prehospital services (58.6%) and rocuronium by 12 (41.4%). In 11 services (91.7%), a dose of 1 mg/kg of rocuronium was used, and in one service, 1.2 mg/kg (8.3%) was used. No services using rocuronium carried sugammadex. In five services, slower relaxation time was found using rocuronium (41.7%), and in seven services, no difference in intubation conditions were noted (58.3%). Contraindications to rocuronium use included high probability of difficult airway and anaphylaxis.ConclusionUse of rocuronium as first-line muscle relaxant in prehospital RSI is increasing. Continued auditing of practice will ascertain which services have adopted change and identify if complications of failed intubation increase as a result.HartleyEL, AlcockR. Rocuronium versus suxamethonium: a survey of first-line muscle relaxant use in UK prehospital rapid sequence induction. Prehosp Disaster Med. 2015;30(2):1-3.

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Rapid sequence induction/intubation controversies

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920910835 ◽

2020 ◽

pp. 102490792091083

Author(s):

Prihatma Kriswidyatomo ◽

Maharani Pradnya Paramitha

Keyword(s):

Positive Pressure Ventilation ◽

Cricoid Pressure ◽

Rapid Sequence Induction ◽

Blocking Agent ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agent ◽

Rapid Sequence Intubation ◽

Positive Pressure ◽

Rapid Sequence ◽

Sequence Induction

Backgrounds: Since its first definition and publication on 1970, Rapid Sequence Induction / Intubation (RSI) technique has been accepted globally as the “standard” for doing rapid intubation after induction of anesthesia for patients with high risk of aspiration, especially in emergency situation. However, this technique is not so much a “standard” as there are numerous variations on its practice based on national surveys. Anesthesia providers have their own opinions on the practice of RSI components which need to be discussed to assess their advantages and disadvantages, while there has been no review article which discussed these controversies in the last ten years. Objectives: To review the technique differences within RSI protocols. Methods: Online databases were searched, including MEDLINE and COCHRANE for each step in the original RSI protocol using keywords such as: “rapid sequence induction” or “rapid sequence intubation” or “RSI” and “controversies” or “head position” or “cricoid pressure” or “neuromuscular blocking agent” or “NMBA” or positive pressure ventilation” or “PPV”; and so on. Articles were then sorted out based on relevancy. Results and conclusion: Supported by new evidence, RSI practices may differ in: the positioning of patient, choices of induction agent, application of cricoid pressure, choices of neuromuscular blocking agent, and the use of positive pressure ventilation. A more updated and standardized guideline should be established by referring and evaluating to these controversies.

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