Comparison of Rocuronium and Succinylcholine for Rapid Sequence Induction in patients undergoing surgery under General Anaesthesia

Objectives: To compare the frequency of excellent intubation condition with Succinylcholine and rocuronium for rapid sequence induction in patients undergoing surgery under general anesthesia. Design: Randomized control trial. Place and duration of study: Department of anesthesiology and pain medicine, Combined Military Hospital Malir Cantt Karachi from 25th June to 10th August 2019. Methodology: In this randomized control trial, a non-probability consecutive sampling technique was used. Anesthesia was given through a standard approach. Then patients were randomly divided into two equal groups. In group A, succinylcholine (1mg/Kg) was given while in group B, rocuronium (1mg/Kg) was given. Laryngoscopy was attempted after 60 seconds. Intubating conditions were labeled as excellent, good, poor, and impossible. All the data was collected in two groups, the data was entered and analyzed on SPSS version 21. Results: The mean age of the patients was 40.11±9.49 years. The male to female ratio of the patients was 0.7:1. The study results showed the excellent intubation conditions were noted in 11 from group A and 9 from group B, good intubation condition was noted in 29 from group A and 25 from group B, poor conditions were noted in 17 from group A and 16 from group B and the impossible intubation conditions were noted in 13 from group A and 20 from group B. Statistically insignificant difference was found between the study groups with intubation conditions i.e. p-value=0.570. Conclusion: It has been proved in our study that both the succinylcholine and rocuronium are statically equally effective in terms of excellent intubation conditions in the management of rapid sequence induction in patients undergoing surgery under general anesthesia.

Magnesium sulfate reduces the rocuronium dose needed for satisfactory double lumen tube placement conditions in patients with myasthenia gravis

Background: Using a minimum dose of neuromuscular blockade (NMB) to achieve intubation condition is one of the goals in anaesthesia management of patients with myasthenia gravis (MG) for thoracoscopic (VATS) thymectomy. However, tracheal intubation with double lumen tube (DLT) could be challenging if intubation condition is not optimal. This double-blind randomised controlled study was designed to investigate whether magnesium sulfate would reduce the rocuronium dose needed for DLT intubation and improve the DLT placement condition for patients with MG who were scheduled for video-assisted thoracoscopic (VATS) thymectomy. Methods: Recruited patients were randomly assigned to receive magnesium sulfate 60mg.kg -1 or normal saline (control) prior to the administration of NMB. Titrating dose of rocuronium was administered to achieve train of four (TOF) ratio less than 10% before DLT intubation. The primary outcome was the rocuronium dose required to achieve TOF ratio less than 10%. The secondary outcome was intubation condition for DLT placement. Results: Twenty-three patients had received magnesium sulfate and 22 patients had received normal saline before rocuronium administration. The required rocuronium dose[mean (standard deviation)] were 0.10 (0.05) mg.kg -1 and 0.28(0.17) mg.kg -1 in patients who had magnesium sulfate and normal saline respectively( P <0.0001). With a similar depth of neuromuscular blockade and depth of anaesthesia, 100% of patients in the magnesium sulfate group and 72.7% of patients in the control group showed excellent intubation condition ( P = 0.027) respectively. The patients in both groups had similar emergence characteristics. Conclusions: Magnesium sulfate is associated with a decrease in rocuronium requirement for an optimal DLT intubation condition in patients with MG for VATS thymectomy. Trial registration: Clinical Trial Registry of China (http://www.chictr.org.cn ) identifier：ChiCTR-1800017696, retrospectively registered on August 10, 2018. Key words : Magnesium sulfate; double lumen tube; myasthenia gravis; intubation; rocuronium

Magnesium sulfate reduces the rocuronium dose needed for satisfactory double lumen tube placement conditions in patients with myasthenia gravis

Background: Using a minimum dose of neuromuscular blockade (NMB) to achieve intubation condition is one of the goals in anaesthesia management of patients with myasthenia gravis (MG) for thoracoscopic (VATS) thymectomy. However, tracheal intubation with double lumen tube (DLT) could be challenging if intubation condition is not optimal. This double-blind randomised controlled study was designed to investigate whether magnesium sulfate would reduce the rocuronium dose needed for DLT intubation and improve the DLT placement condition for patients with MG who were scheduled for video-assisted thoracoscopic (VATS) thymectomy. Methods: Recruited patients were randomly assigned to receive magnesium sulfate 60mg.kg-1 or normal saline (control) prior to the administration of NMB. Titrating dose of rocuronium was administered to achieve train of four (TOF) ratio less than 10% before DLT intubation. The primary outcome was the rocuronium dose required to achieve TOF ratio less than 10%. The secondary outcome was intubation condition for DLT placement. Results: Twenty-three patients had received magnesium sulfate and 22 patients had received normal saline before rocuronium administration. The required rocuronium dose[mean (standard deviation)] were 0.10 (0.05) mg.kg-1 and 0.28(0.17) mg.kg-1 in patients who had magnesium sulfate and normal saline respectively(P<0.0001). With a similar depth of neuromuscular blockade and depth of anaesthesia, 100% of patients in the magnesium sulfate group and 72.7% of patients in the control group showed excellent intubation condition (P = 0.027) respectively. The patients in both groups had similar emergence characteristics. Conclusions: Magnesium sulfate is associated with a decrease in rocuronium requirement for an optimal DLT intubation condition in patients with MG for VATS thymectomy.

Magnesium sulfate reduces rocuronium dose needed for satisfactory double lumen tube placement condition in patients with myasthenia gravis

Background: Using minimum dose of neuromuscular blockade (NMB) to achieve intubation condition is the goal in management of patients with myathenia gravis (MG). However, tracheal intubation with double lumen tube (DLT) can be challenging if intubation condition is not optimal. This double-blind randomised controlled study was designed to investigate whether magnesium sulfate would reduce rocuronium dose needed and improve the DLT placement conditions for patients with MG who were scheduled for video-assisted thoracoscopic (VATS) thymectomy. Methods: Recruited patients were randomly assigned to receive magnesium sulfate 60mg.kg-1 or normal saline (control) prior to the administration of NMB. Titrating dose of rocuronium was administered to achieve train of four ratio (TOF%) to 10% or below before DLT intubation. The primary outcome was the rocuronium dose required to achieve TOF% below 10%. Secondary outcome was intubation condition for DLT placement. Results: Twenty-three patients had magnesium sulphate and 22 patients had normal saline before rocuronium administration. The required rocuronium dose used were 0.10 (0.05) mg.kg-1 and 0.28(0.17) mg.kg-1 in patients who had magnesium sulphate and normal saline respectively (P<0.0001). With a similar depth of neuromuscular blockade and depth of anaesthesia, 23 patients in the magnesium sulphate group and 16 patients in the control group had excellent intubation condition (P = 0.027). The patients in both groups had similar emergence characteristics. Conclusions: Magnesium sulfate is associated with a decrease in the rocuronium requirement and better DLT intubation condition in patients with MG.

Magnesium sulfate decreases the dose of rocuronium for satisfactory double lumen tube placement condition in patients with myasthenia gravis

Background: Titrating a low dose of non-depolarizing neuromuscular blockers for induction of general anesthesia for patients with myasthenia gravis (MG) is a popular accepted practice. This practice may confront with unsatisfactory intubation conditions, especially for double lumen tube (DLT). This double-blind randomised study was to investigate whether magnesium sulfate could decrease the rocuronium demand and improve the DLT placement conditions for MG patients who scheduled for video-assisted thoracoscopic (VATS) thymectomy. Methods: The patients were randomly assigned into the magnesium sulfate or normal saline group. After acquiring the adequate sedative depth, magnesium sulfate(60mg.kg-1) or normal saline(control) was given to the patients in two groups respectively. After that, the same Train of Four (TOF) value was obtained with one or more doses of 0.05 mg.kg-1 rocuronium with 3 minutes interval, then DLT was intubated. The primary and secondary observational outcomes were the cumulative rocuronium dose and the intubation condition for DLT placement respectively. Results: 23 patients in the magnesium sulphate group and 22 patients in the control group completed the study. The amount of rocuronium used to meet the setting value of TOF were 0.10 (0.05)mg.kg-1 and 0.28(0.17) mg.kg-1 in the magnesium sulphate and control group respectively (P<0.0001). Under a similar depth of neuromuscular blockade and sedation, 23 patients in magnesium sulphate group and 16 patients in control group showed excellent intubation condition. The patients in both groups showed similar characteristics of recovery from neuromuscular blockade. Conclusions: Our research showed that magnesium sulfate could decrease the rocuronium demand for satisfactory DLT intubation condition in MG patients.

Magnesium sulfate decreases the dose of rocuronium for satisfactory double lumen tube placement condition in patients with myasthenia gravis

Background: Titrating a low dose of non-depolarizing neuromuscular blockers for induction of general anesthesia for patients with myasthenia gravis (MG) is a popular accepted practice. This practice may confront with unsatisfactory intubation conditions, especially for double lumen tube (DLT). This double-blind randomised study was to investigate whether magnesium sulfate could decrease the rocuronium demand and improve the DLT placement conditions for MG patients who scheduled for video-assisted thoracoscopic (VATS) thymectomy. Methods: The patients were randomly assigned into the magnesium sulfate or normal saline group. After acquiring the adequate sedative depth, magnesium sulfate(60mg.kg-1) or normal saline(control) was given to the patients in two groups respectively. After that, the same Train of Four (TOF) value was obtained with one or more doses of 0.05 mg.kg-1 rocuronium with 3 minutes interval, then DLT was intubated. The primary and secondary observational outcomes were the cumulative rocuronium dose and the intubation condition for DLT placement respectively. Results: 23 patients in the magnesium sulphate group and 22 patients in the control group completed the study. The amount of rocuronium used to meet the setting value of TOF were 0.10 (0.05)mg.kg-1 and 0.28(0.17) mg.kg-1 in the magnesium sulphate and control group respectively (P<0.0001). Under a similar depth of neuromuscular blockade and sedation, 23 patients in magnesium sulphate group and 16 patients in control group showed excellent intubation condition. The patients in both groups showed similar characteristics of recovery from neuromuscular blockade. Conclusions: Our research showed that magnesium sulfate could decrease the rocuronium demand for satisfactory DLT intubation condition in MG patients.

Evaluation of intubation condition following administration of rocuronium in comparison to atracurium in paediatric patients

Background. Optimum intubation condition is paramount important for early and easy passage of endotracheal tube through the glottis and that results from adequate muscle relaxation. Rocuronium and atracurium are muscle relaxants used for short and intermediate duration of surgical processes. Objective: This study, compares the intubation condition and haemodynamic changes in paediatric patients following administration of rocuronium and atracurium to get rid of the side effects of succinylcholine. Method. The study was carried out in 60 patients aged 11/2 to 10 years, ASA I-II, under general anaesthesia. The patients were divided into two groups: rocuronium Gr R and atracurium Gr A. Induction was done with halothane 3.5-4% and for intubation rocuronium 0.6 mg/kg and atracurium 0.46 mg/kg were given to patients of Gr R and Gr A respectively. The intubation condition was assessed and gradded at 60 seconds after neuromuscular blocking agents. At the same time TOF ratios were recorded. Results. Rocuronium produced good to excellent intubation condition (score 3.80 ± 0.07) in all patients at 60 seconds whereas that of atracurium poor intubation condition (score 2 ± 0.00). TOF ratios showed more relaxation of adductor pollicis muscle in Gr R than Gr A (Gr R = 60.43 ± 0.87, Gr A = 78.90 ± 0.72). (p < 0.001). Cardiovascular stability was not significantly difference in both the groups before induction and intubation. Conclusion. Rocuronium produced better intubation condition in comparison to atracurium. DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18150 Journal of BSA, 2010; 23(1): 3-7