Thiopental-Rocuronium Versus Ketamine-Rocuronium for Rapid-Sequence Intubation in Parturients Undergoing Cesarean Section

Baraka, Anis; Sayyid, Sahar S.; Assaf, Boutros

doi:10.1097/00000539-199705000-00027

Cited by 36 publications

(34 citation statements)

References 15 publications

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“…Hence intravenous anaesthetic agents with the shortest t 1 ⁄ 2 K eo are generally best suited to the non-titrated use in RSI (Table 1). Consistent with this notion, a study using ketamine 1.5 mg.kg )1 vs thiopentone 4 mg.kg )1 in obstetric practice (RSI with rocuronium 0.6 mg.kg )1 ) reported satisfactory conditions for early intubation (45 s) in all cases in ketamine, while thiopentone caused difficulty in 75% of cases [5].…”

Section: Pharmacokinetics and Pharmacodynamics In Shocked Patientsmentioning

confidence: 65%

Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?

et al. 2009

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Summary In rapid sequence induction of anaesthesia in the emergency setting in shocked or hypotensive patients (e.g. ruptured abdominal aortic aneurysm, polytrauma or septic shock), prior resuscitation is often suboptimal and comorbidities (particularly cardiovascular) may be extensive. The induction agents with the most favourable pharmacological properties conferring haemodynamic stability appear to be ketamine and etomidate. However, etomidate has been withdrawn from use in some countries and impairs steroidogenesis. Ketamine has been traditionally contra‐indicated in the presence of brain injury, but we argue in this review that any adverse effects of the drug on intracranial pressure or cerebral blood flow are in fact attenuated or reversed by controlled ventilation, subsequent anaesthesia and the greater general haemodynamic stability conferred by the drug. Ketamine represents a very rational choice for rapid sequence induction in haemodynamically compromised patients.

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Section: Pharmacokinetics and Pharmacodynamics In Shocked Patientsmentioning

confidence: 65%

Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?

et al. 2009

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“…In the present study, the two groups differed only in the induction agent. In a study comparing thiopentone-rocuronium with ketamine-rocuronium for rapid sequence intubation in parturients undergoing Caesarean section, intubating conditions at 50% neuromuscular block of the adductor pollicis were significantly better after ketamine than after thiopentone [14]. In that study, neither the time to 50% neuromuscular block nor the onset time were significantly different between the two groups.…”

Section: Discussionmentioning

confidence: 87%

Influence of induction of anaesthesia on intubating conditions one minute after rocuronium administration: comparison of ketamine and thiopentone

et al. 1999

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We compared the effect of thiopentone and ketamine on intubating conditions after rocuronium 0.6 mgkg−1 in two groups of patients (n = 16 each), aged 21–44 years, undergoing elective surgery. Premedication consisted of alprazolam 1 mg by mouth 1 h before surgery. All patients received midazolam 2 mg intravenously 2 min before intravenous administration of thiopentone 5 mgkg−1 or ketamine 2.5 mgkg−1. Muscle relaxation was provided by rocuronium 0.6 mgkg−1. One minute after rocuronium administration, tracheal intubation was performed within 15 s by a skilled anaesthetist blinded to the treatment group assignment. Intubating conditions were graded as excellent, good, fair or poor on the basis of jaw relaxation, position of vocal cords and diaphragmatic response. Neuromuscular transmission was assessed at the adductor pollicis muscle using a TOF‐GUARD™ monitor. Excellent and good intubating conditions were obtained in 100% of patients in the ketamine group and in 50% of patients in the thiopentone group (p = 0.002). Jaw relaxation was similar in both groups but vocal cord conditions were better and the diaphragmatic response less marked in the ketamine group compared with the thiopentone group (p = 0.002). The degree of neuromuscular block [% decrease of T1, mean (SD)] at the time of intubation was similar: 51.8 (25)% (ketamine group) and 54.3 (23.1)% (thiopentone group). We conclude that ketamine 2.5 mgkg−1 provides better intubating conditions than thiopentone 5 mgkg−1 1 min after administration of rocuronium 0.6 mgkg−1.

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“…Baraka et al and Hans et al showed that ketamine provided better intubation conditions than thiopental. 20,21 However, the ketamine doses used in these studies were 1.5 mg kg -1 and 2.5 mg kg -1 , respectively. Ledowski and Wulf 22 found that the intubation conditions of 0.6 mg.kg -1 rocuronium were better in ketamine-etomidate induction group; however, arterial blood pressure and heart rate were also higher in this group.…”

Section: Discussionmentioning

confidence: 99%

The Effects of a Subhypnotic Dose of Ketamine on Neuromuscular Block Characteristics of Rocuronium and Intubation Quality

Abduşoğlu¹,

Turan²,

Yurtlu³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T OOb bj je ec ct ti iv ve e: : In this study, we aimed to examine the effects of a subhypnotic dose of ketamine on the neuromuscular block characteristics of rocuronium and intubation quality. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Sixty patients in ASA I-II risk group were included in the study. Group S received 5 mL of 0.9% saline and Group K received 0.5 mg.kg -1 ketamine in 5 mL volume, one minute before induction. Both groups had anesthesia induction with a propofol dose of 2.5 mg.kg -1 (Propofol 1%, Fresenius Kabi). This was considered as anesthesia start time. After 1 min, a control single twitch stimulus (0.1 Hz) was applied and recorded. All patients were given 0.6 mg.kg -1 rocuronium (Esmeron ® 50 mg.5 ml -1 N.V. Organon, Oss, Holland) in 5 sec. When the single twitch response was depressed 100%, the patient was intubated and the full depression time (onset time) was noted. Anesthesia maintenance was achieved with O 2 /N 2 O and sevoflurane. Following the intubation, the application of train-of -four (TOF) stimulation was started. When the TOF ratio reached to 20%, rocuronium was repeated at a dose of 0.2 mg.kg . Clinical duration (T25), recovery index (T25-75) and spontaneous recovery time to TOF > 0.9 were recorded. Intubation conditions were assessed by using the scale of Fuchs-Buder. The additional drugs used during the operation and neuromuscular blocker amounts were recorded. The hemodynamic values of both groups were recorded throughout the study. Postoperative recovery times, visual analogue pain scores (VAS) and Ramsay sedation scores were also recorded. R Re es su ul lt ts s: : The time for 100% depression of single twitch in Group K was shorter than that of Group S (p<0.05). The clinical duration, recovery index and spontaneous recovery duration of the first dose of rocuronium were longer in Group K compared to Group S (p<0.05). There was no difference between the total neuromuscular blocker amounts of the study groups. There was no significant difference between the groups according to intubation scores (p>0.05), recovery times (p>0.05), VAS scores, Ramsay sedation scores or mean arterial pressure values. When the mean heart rate values of the groups were compared, all values of Group K were higher than those of Group S except control and 60 th min values (p<0.001). C Co on nc cl lu us si io on n: : According to our findings, ketamine in a subhypnotic dose shortens the onset time of rocuronium block and extends the clinical duration of first dose of rocuronium without improving the intubation quality.K Ke ey y W Wo or rd ds s: : Ketamine; propofol; rocuronium Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada subhipnotik doz ketaminin rokuronyumun nöromusküler blok özellikleri ve entübasyon kalitesi üzerindeki etkilerini incelemeyi amaçladık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : ASA I-II risk grubundaki 60 hasta çalışmaya alındı. Grup S'ye 5 mL %0,9 serum fizyolojik verildi, Grup K'ya indüksiyondan bir dakika önce 5 mL 0,5 mg.kg -1 ketami...

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Thiopental-Rocuronium Versus Ketamine-Rocuronium for Rapid-Sequence Intubation in Parturients Undergoing Cesarean Section

Cited by 36 publications

References 15 publications

Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?

Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?

Influence of induction of anaesthesia on intubating conditions one minute after rocuronium administration: comparison of ketamine and thiopentone

The Effects of a Subhypnotic Dose of Ketamine on Neuromuscular Block Characteristics of Rocuronium and Intubation Quality

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