A large simple randomized trial of rocuronium versus succinylcholine in rapid‐sequence induction of anaesthesia along with propofol

Abstract

Rocuronium 1.0 mg/kg given along with propofol in a rapid-sequence induction of anaesthesia is clinically equivalent to succinylcholine 1.0 mg/kg.

Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

“…For this reason, rocuronium has been recommended as a component of a rapid sequence induction of anesthesia at doses varying from 0.6 to 1.2 mg Á kg -1 (2-4 times the effective dose for 95% twitch depression or 2 to 4 9 ED 95 ) to obtain intubating conditions equivalent to those achieved with succinylcholine. [3][4][5][6][7] However, such high doses of rocuronium have a prolonged duration of action, 8 which may not be suitable for surgery of short duration. Kopman et al demonstrated that lower doses of rocuronium (1.5 9 ED 95 ) provide clinically acceptable conditions for intubation 75 s after drug administration.…”

The optimal dose of rocuronium for rapid sequence induction

“…4 Higher doses (1 mg Á kg -1 ) are recommended when rapid tracheal intubation is indicated. 5 Low doses will also result in a less intense block at the laryngeal adductors, which are known to be more resistant than skeletal muscles to the action of rocuronium. 6 Using a 0.25 mg Á kg -1 dose, Meistelman et al found the maximum block attained at the vocal cords to be only 37 ± 8%.…”

Succinilcolina: 50 anos de soberania

“…It was initially preconized in 0.6 mg.kg -1 doses for tracheal intubation 5,7,8 , with successful intubation reports similar to those obtained with succinylcholine. With the development of clinical observations and research, it was found that 1 mg.kg -1 doses or even doses higher than 2 mg.kg -1 may be used when the goal is to assure intubation time and conditions similar to those obtained with succinylcholine 3,[9][10][11][12][13][14][15] . However, is spite of excellent tracheal intubation conditions, such high rocuronium doses imply significantly longer duration, thus counterindicating the technique for short procedures 14 .…”

“…Primeiramente se preconizou o uso de doses de 0,6 mg.kg -1 para intubação traqueal 5,7,8 com relatos de sucesso de intubação semelhantes ao obtido com a succinilcolina. Com o evoluir das observações clínicas e das pesquisas, concluiu-se que doses de 1 mg.kg -1 ou mesmo doses superiores a 2 mg.kg -1 devem ser empregadas quando se deseja garantia de tempo e de condições de intubação semelhantes as registradas com a succinilcolina 3,[9][10][11][12][13][14][15] . No entanto, a despeito de se obter excelentes condições de intubação traqueal, essas altas doses de rocurônio implicam em uma duração de ação expressivamente maior, limitando o uso da técnica em procedimentos curtos 14 .…”