Comparison of intubating conditions after rapacuronium (Org 9487) and succinylcholine following rapid sequence induction in adult patients

Sparr, H. J.; Mellinghoff, Hermann; Blobner, Manfred; Nöldge-Schomburg, Gabriele

doi:10.1093/bja/82.4.537

Cited by 65 publications

(28 citation statements)

References 15 publications

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“…The efficacy of 2-3 times the ED 90 of rapacuronium in a rapid-sequence setting was evaluated in two large European studies [34,35]. Under such conditions clinically acceptable intubation conditions may be achieved within 90 s in the majority of adult and elderly patients with rapacuronium in doses equal to or greater than 1.5 mg kg À1 .…”

Section: Rapacuroniummentioning

confidence: 99%

Choice of the muscle relaxant for rapid-sequence induction

Sparr¹

2001

European Journal of Anaesthesiology

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Muscle relaxants are given as part of a rapid-sequence induction to facilitate tracheal intubation. Among all the muscle relaxants available, succinylcholine is the only one with a fast (ffi1 min) onset and a fast recovery. Therefore it is still the most frequently used muscle relaxant for rapid-sequence induction despite its wellknown side-effects. The short duration of action of succinylcholine is, however, no substitute for aggressive airway management in the case of an unexpectedly difficult intubation in order to prevent life-threatening hypoxia. A preoperative assessment of the airway is mandatory in any patient and may indicate the need for using intubation techniques without a muscle relaxant. Rocuronium in large doses (i.e. !1 mg kg À1 ) is an alternative to succinylcholine in a classical rapid-sequence setting under relatively light anaesthesia. With respect to rapid tracheal intubation, the timing and priming principles offer little advantage over the use of rocuronium in doses of 0.6 mg kg À1 in combination with an appropriate induction technique (i.e. including an opioid) or over the use of larger doses of rocuronium (!1.0 mg kg À1 ) under relatively light anaesthesia, and may even be potentially harmful.In contrast to rocuronium, the use of rapacuronium in a rapid-sequence setting has been associated with dose-dependent respiratory side-effects that limit its usefulness in doses higher than 1.5 mg kg À1 for this indication.

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Section: Rapacuroniummentioning

confidence: 99%

Choice of the muscle relaxant for rapid-sequence induction

Sparr¹

2001

European Journal of Anaesthesiology

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“…Other studies (23–25) recorded the range of excellent intubating conditions after the administration of 1.0 mg/kg succinylcholine in a simulated rapid-sequence induction in elective cases of 63% to 74%. It is a lower incidence than those in our current study that dealt with emergency critically ill cases (ASA III & IV).…”

Section: Discussionmentioning

confidence: 99%

The optimal succinylcholine dose for intubating emergency patients: retrospective comparative study

Ezzat

Fathi

Zarour

et al. 2011

Libyan Journal of Medicine

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BackgroundSuccinylcholine remains the drug of choice for satisfactory rapid-sequence tracheal intubation. It is not clear from the literature why the 1 mg/kg dose of succinylcholine has been traditionally used. The effective dose (ED95) of succinylcholine is less than 0.3 mg/kg. The dose of 1 mg/kg represents 3.5 to 4 times the ED95.ObjectivesTo compare the effect of the traditionally used 1 mg/kg of succinylcholine with lower doses of 0.6 mg/kg and 0.45 mg/kg on intubation condition regarding the onset time, duration of action, duration of abdominal fasciculation, and the intubation grading.MethodsThis retrospective comparative study was carried into three groups of ASA III & IV (American Society of Anesthesiologist's Physical Status III and IV) non-prepared emergency patients who were intubated at emergency department of Hamad General Hospital, Doha, Qatar during January 1st 2007 to August 31, 2010. The Institutional Research Board (IRB) approval was obtained. This study was limited to 88 patients who received fentanyl 1µg/kg followed by etomidate 0.3 mg/kg intravenously as induction agents and succinylcholine as a muscle relaxant agent in doses of 0.45 mg/kg, 0.6 mg/kg, or 1 mg/kg.ResultsIncreasing the succinylcholine dosage shortened the onset time, prolonged the duration of action, and prolonged the duration of abdominal fasciculation significantly (P<.001). Tracheal intubation was 100% successful in the three groups of patients.ConclusionSuccinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III & IV emergency non-prepared patients. Duration of action of succinylcholine is dose dependent; reducing the dose allows a more rapid return of spontaneous respiration and airway reflexes.

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“…Dabei haben die Nichtanwender ein noch höheres Interesse an einer Ersatzsubstanz, das sich natürlich auch in ihrer Einsatzvermeidung manifestiert. Ein Ersatz mit vollständig gleichem pharmakokinetischen und -dynamischen Profil ist trotz der Entwicklungen von Mivacurium, Rocuronium und Rapacuronium nicht in Sicht[6,11,23,26,27]. So könnte dieses deutliche deutsche Votum eine internationale Meinungsbildung veranlassen, um die Pharmaindustrie überzeugen zu können, dass weiter nach einem Ersatz für das Succinylcholin gesucht werden muss.…”

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Anwendung von Muskelrelaxanzien zur Routineeinleitung in Deutschland

Geldner¹,

Fuchs-Buder²,

Hofmockel

et al. 2003

Der Anaesthesist

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The aim of this study was to evaluate the use of muscle relaxants during induction of anesthesia in patients without risk of aspiration of stomach contents. Of the 2,996 questionnaires sent out, 2,054 (68.6%) could be analysed and the results show that succinylcholine is used regularly in 13.6% of anesthesia departments. The next most commonly used muscle relaxants are atracurium, vecuronium and mivacurium, followed by cis-atracrium, rocuronium and pancuronium. Alcuronium is the least frequently used muscle relaxant. During induction of an elective anesthesia procedure, a priming technique is used by 19% of anesthesiologists, 22% utilize precurarization, and a timing technique is performed in 7.1%. The use of muscle relaxants for on-going relaxation follows the same pattern as for induction of neuromuscular blockade and succinylcholine is used in 1.4% if further relaxation is needed. The desire for specific qualities of muscle relaxants is correlated with higher use of the specific substance: short onset time for rocuronium, good controllability with mivacurium, no side-effects with cisatracurium and economical aspects with alcuronium. Of the participants 76.6% voiced the desire for a non-depolarizing replacement for succinylcholine.Private practices use mivacurium more often than hospitals, level one hospitals use rocuronium and cisatracurium more often. This survey could not show a definite standard of use in terms of muscle relaxants for an elective case.Precurarization, priming and timing are used frequently in patients not at risk of aspiration. This should be reduced by on-going teaching.

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Comparison of intubating conditions after rapacuronium (Org 9487) and succinylcholine following rapid sequence induction in adult patients

Cited by 65 publications

References 15 publications

Choice of the muscle relaxant for rapid-sequence induction

Choice of the muscle relaxant for rapid-sequence induction

The optimal succinylcholine dose for intubating emergency patients: retrospective comparative study

Anwendung von Muskelrelaxanzien zur Routineeinleitung in Deutschland

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