Rocuronium Is Not Associated with More Vocal Cord Injuries than Succinylcholine After Rapid-Sequence Induction: A Randomized, Prospective, Controlled Trial

Abstract

Postoperative hoarseness (PH), sore throat (ST), and vocal cord injuries (VCI) are common complications after general anesthesia. Excellent endotracheal intubating conditions are associated with less laryngeal morbidity than good or poor intubating conditions. Thus, we tested the hypothesis that a rapid-sequence induction (RSI) with succinylcholine would lead to less PH and VCI than with rocuronium. In this prospective trial, 160 patients were randomized in 2 groups to receive thiopental 5.0 mg/kg, fentanyl 3.0 microg/kg, succinylcholine 1.0 mg/kg, or rocuronium 0.6 mg/kg during RSI. PH and ST were assessed at 24, 48, and 72 h after surgery, VCI were examined by stroboscopy in those patients who had PH >3 days. Excellent and clinically acceptable intubating conditions were significantly increased in the succinylcholine group compared with the rocuronium group: 57% versus 21% and 89% versus 59%, respectively (P < 0.001). The incidence and severity of PH, and VCI between the succinylcholine and the rocuronium groups did not differ significantly: PH: 50% versus 51% (P = 0.99) and VCI: 3% versus 1% (P = 0.98), respectively. Similar findings were found for ST, 39% versus 28% (P = 0.22), and postoperative myalgia, 39% versus 29% (P = 0.25), respectively. Intubating conditions were significantly better in the succinylcholine group compared with the rocuronium group. The incidence and severity of ST and myalgia were not increased in the patients receiving succinylcholine. However, the rate of PH and VCI was similar to the rocuronium group.

Impact of Endotracheal Tube Cuff Pressure on Postoperative Sore Throat: A Systematic Review and Meta-Analysis

“…POST continues to be reported with a high frequency and can sometimes persist for several days (3). The incidence of POST ranges from 21% to 71.8% (4)(5)(6), while the incidence of postoperative hoarseness (PH) is between 40% and 50% (3,7).…”

Voice changes after thyroidectomy: an experience with 364 cases of thyroid surgery

“…19 The incidence of laryngeal complications caused by orotracheal intubation is about 6%-70% after thyroid surgery. (20)(21)(22) In present study, out of 364 patients cervical epidural anaesthesia and orotracheal intubation were done in 182(50%) and 182(50%) patients respectively. Voice changes secondary to laryngeal complications were more in patients in which orotracheal intubation were performed (67.77% Vs 51.65%; p-0.00281) ( Table 7).…”

Pharmacoeconomics and Pharmacodynamic Interactions of Rocuronium and Pancuronium

“…In addition to obtaining faster onset time, good intubation conditions are also essential requirements. Excellent endotracheal intubation conditions are associated with less laryngeal morbidity than good or poor intubation conditions [7,8] (Table 4). e intubation conditions with rocuronium with a dose of 2X ED 95 were inferior to that produced by suxamethonium [9].…”