Onset and Recovery of Rocuronium (Org 9426) and Vecuronium Under Enflurane Anaesthesia

Mayer, M.; Doenicke, A.; Hofmann, Alexandria; Peter, K.

doi:10.1093/bja/69.5.511

Cited by 49 publications

(19 citation statements)

References 4 publications

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“…The faster onset of good and excellent tracheal intubation conditions we found with rocuronium compared to vecuronium in this study are in keeping with those reported in other studies [10][11][12][13].…”

Section: Discussionsupporting

confidence: 93%

Tracheal intubation conditions after one minute: rocuronium and vecuronium, alone and in combination

1997

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SummaryRocuronium is a recently introduced nondepolarising neuromuscular blocking agent with a rapid onset and intermediate duration of action. Experimental observations have suggested that during onset it acts synergistically with other nondepolarising agents, but that at a steady state the combined action is additive. In order to investigate whether synergism during onset produces a clinical benefit we performed the following study of tracheal intubation conditions. Consenting patients presenting for elective surgery which required tracheal intubation were randomly allocated to receive a standard anaesthetic and either a twice ED 95 dose of rocuronium, or vecuronium, or an equipotent mixture of both drugs. Tracheal intubation conditions were assessed after 60 s and scored as excellent, good, poor or impossible. The conditions produced in the rocuronium and the mixture groups were similar and both were significantly better than those of vecuronium. Excellent intubation conditions were achieved in 57% of the rocuronium group, 70% of the mixture group and 27% of the vecuronium group. We conclude that a mixture of rocuronium and vecuronium acts synergistically during the early part of their action and a mixture containing one ED 95 of both agents provides comparable conditions for tracheal intubation as an equipotent dose of rocuronium. Rocuronium is a nondepolarising neuromuscular blocking drug which provides a rapid onset of action with an intermediate duration [1][2][3]. It is particularly useful for patients who require rapid tracheal intubation as it reliably provides good intubation conditions within 1 min of intravenous administration [1][2][3][4].A chance observation in an earlier study suggested that a mixture of rocuronium and vecuronium provided a faster onset of neuromuscular blockade than an equipotent dose of rocuronium alone, even though the maximum degree of blockade attained remained unaffected. Naguib reported that a mixture of rocuronium and mivacurium has an additive action at a steady state, but a review of his results supports the observation of a faster speed of onset for a combination of rocuronium with mivacurium [5]. Kim & Cho have also studied the interaction of rocuronium with mivacurium [6]. A review of their results suggests that the onset times of mixtures of mivacurium and rocuronium are shorter than would be anticipated if the two drugs had an additive action. However, their results also show that the recovery indices of the mixtures are close to that expected for an additive action of the two drugs during recovery. These studies imply that rocuronium may act synergistically with other nondepolarising agents during onset of blockade, but that when a steady state is reached the early synergistic effect is overwhelmed by an alternative mechanism of action which results in an additive effect with other nondepolarising drugs. It also implies that the quality of tracheal intubation conditions achieved after 1 min might be enhanced by using an equipotent mixture of rocuronium with anothe...

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Section: Discussionsupporting

confidence: 93%

Tracheal intubation conditions after one minute: rocuronium and vecuronium, alone and in combination

1997

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“…There were no significant differences between the groups. Rocuronium is an isotonic solution with a pH of 4.0 by adding acetic acid or sodium hydroxide [13,14]. The pH of rocuronium in this study was 3.9 ± 0.1.…”

Section: Discussionmentioning

confidence: 91%

“…Rocuronium bromide is a new aminosteroidal nondepolarizing competitive neuromuscular blocking agent that is structurally related to vecuronium and is characterized by rapid onset and intermediate duration of action [14,15]. Injection of rocuronium is accompanied by a severe burning pain that results in brisk flexion of the elbow and wrist, which has been observed after induction of anesthesia [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

Neutralized rocuronium (pH 7.4) before administration prevents injection pain in awake patients: a randomized prospective trial

Han

Koo

Choi

et al. 2007

Journal of Clinical Anesthesia

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“…Mayer et al, 22 stated that satisfactory intubating conditions were found with vecuronium at 60 seconds and none of them were excellent.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study to Evaluate the Efficacy of Rocuronium and Vecuronium for Rapid Sequence Intubation in Adults

Dwivedi¹,

Kaur²,

Jindal³

et al. 2015

jemds

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AIMS AND OBJECTIVES:To determine the efficacy of Rocuronium and Vecuroniumthe two newer non depolarizing neuromuscular blocking agents for rapid sequence intubation in adults undergoing surgical operations. MATERIAL AND METHOD: The present study was conducted on 60 healthy adult patients of ASA grade I and II, of either sex, requiring intubation for various surgical operations. Patients were randomly divided into 2 groups of 30 each: GROUP I (n=30) received i.v 1.2mg/kg body wt. of Rocuronium. GROUP II (n= 30) received i.v 0.15mg/kg body wt of Vecuronium. Intubation done at 60 seconds in both the groups. RESULTS: Excellent intubating conditions were achieved in almost 66% of patients whereas 33% had good intubating conditions in group I. On the other hand only 10% of patients showed excellent intubating conditions whereas majority (56%) showed good intubating conditions in group II. Both the groups showed significant increase in heart rate 1 min after intubation. In rocuronium group this increase in heart rate was significant at 3 min as well. CONCLUSION: Intubating conditions for rapid sequence intubation are significantly better with rocuronium group. Rocuronium may be considered a suitable alternative for succinylcholine especially in patients who are at risk of adverse effects of succinylcholine. Rocuronium and Vecuronium are haemodynamically stable drugs with no significant adverse effects. KEYWORDS: Rocuronium, Vecuronium, Succinylcholine, Rapid sequence intubation, Hemodynamic parameter. INTRODUCTION:Rapid endotracheal intubation is a lifesaving procedure of securing the airway in critically ill and injured patients as it results in rapid unconsciousness and paralysis in patients who are not fasting and are at risk of vomiting and aspiration. 1 Rapid sequence intubation (RSI) minimizes the time between the loss of consciousness and tracheal intubation. Preoxygenation is a standard component of RSI. 2 Preoxygenation on high fresh gas flows of 100% oxygen via face mask with a good mask fit for 3 to 5 minutes is recommended. Alternatively, a series of 4 vital capacity breaths of 100% oxygen may be used in an emergency. 3,4 The present study was undertaken to study the efficacy of Rocuronium, a newer nondepolarizing muscle relaxant in the dose of 1.2mg/kg and compare it with Vecuronium, 0.15mg/kg for rapid sequence intubation in adults.

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Onset and Recovery of Rocuronium (Org 9426) and Vecuronium Under Enflurane Anaesthesia

Cited by 49 publications

References 4 publications

Tracheal intubation conditions after one minute: rocuronium and vecuronium, alone and in combination

Tracheal intubation conditions after one minute: rocuronium and vecuronium, alone and in combination

Neutralized rocuronium (pH 7.4) before administration prevents injection pain in awake patients: a randomized prospective trial

A Comparative Study to Evaluate the Efficacy of Rocuronium and Vecuronium for Rapid Sequence Intubation in Adults

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