Emergency Intubation of the Trachea Facilitated by Suxamethonium

Abstract

The relationship between the time of onset of neuromuscular blockade and the time at which laryngoscopy was attempted was studied in patients presenting for emergency obstetric or emergency general surgical procedures. "Train-of-four" stimulation and visual observation of the evoked twitch response in the hand were used as a measure of the degree of neuromuscular blockade. The attendant anaesthetist was unaware of the response to the peripheral nerve stimulator. Intubation preceded complete neuromuscular blockade; in the obstetric patients there was no correlation between the two times. The use of a peripheral nerve stimulator should allow the anaesthetist to perform intubation in emergency situations with a greater degree of safety.

Influence of stimulation frequency on rocuronium and pancuronium-induced neuromuscular block onset: acceleromyography evaluation

“…Considering the discrepancy between masseter and adductor pollicis blockade installation, we decided to perform laryngoscopy maneuvers when there was 75% decrease in adductor pollicis contractile responses amplitude. Previous studies 4,22 have resulted in satisfactory tracheal intubation conditions without total disappearance of adductor pollicis responses. The possibility of performing tracheal intubation when rocuronium was used in a dose equivalent to twice DE 95 without maximum adductor pollicis blockade had been already reported by other authors 23 .…”