How low can you go? Lowest effective dose of neuromuscular blocking agent for tracheal intubation

Intubation for short procedures

“…It has been shown to have a lowest optimal dose of 0.2 mg/kg, which provides good intubating conditions within three minutes, and a return of the first twitch on a train-of-four (TOF) at 15 minutes with a full TOF by 30 minutes. 4,5,6 Topicalising the airway The use of lignocaine, sprayed onto the vocal cords, aids intubation, but may not prevent the coughing experienced once the tube enters the trachea. Patients are often uncomfortable, with a resultant hoarse voice that may persist for a few hours.…”

Determining the potency of neuromuscular blockers: are traditional methods flawed?

“…The concept that the 'intubation dose' is equal to the 2Â the ED 95 is an antiquated one. 9 Thus, the ED 95 is a less useful concept than it once was. In defence of the ED 95 , there is some evidence that not all drugs have the same dose -response slope.…”

The optimal dose of rocuronium for rapid sequence induction

“…As pointed out in the accompanying editorial, minor deviations from that technique may lead to different results, including failure to achieve tracheal intubation due to poor relaxation and inadequate intubation conditions. 8 This may increase the risk of aspiration during the rapid sequence induction which the technique was originally instituted to guard against. The authors are to be commended for describing a technique that can be advantageous for brief surgical procedures that require muscle relaxation.…”