Tracheal intubation with rocuronium using a “modified timing principle”

다국어 초록 (Multilingual Abstract)

Background: Rapid sequence induction (RSI) is indicated in various situations. Succinylcholine has been the muscle relaxant of choice for RSI, and rocuronium has become an alternative medicine for patients who cannot be administered succinylcholine for various reasons. Although rocuronium has the most rapid onset time among non-depolarizing muscle relaxants, the standard dose of rocuronium (0.6 mg/kg) takes 60 seconds to achieve appropriate muscle relaxation. We evaluated intubating conditions using the “modified timing principle” with rocuronium and succinylcholine.
Methods: In this prospective controlled blinded study, all patients received 1.5 μg/kg fentanyl intravenously with preoxygenation for 2 minutes and were randomized to receive 0.6 mg/kg rocuronium followed by 1.5 mg/kg propofol or 1.5 mg/kg propofol and 1.5 mg/kg succinylcholine. The rocuronium group was intubated just after confirming loss of consciousness, and the succinylcholine group was intubated 1 minute after injecting succinylcholine. Intubation condition, timing of events, and complications were recorded.
Results: All patients were successfully intubated in both groups. Apnea time of the rocuronium group (38.5 seconds) was significantly shorter than that in the succinylcholine group (100.7 seconds). No significant differences were observed in loss of consciousness time or intubation time. The succinylcholine group tended to show better intubation conditions, but no significant difference was observed. None of the patients complained awareness of the intubation procedure or had respiratory difficulty during a postoperative interview.
Conclusions: The modified RSI with rocuronium showed shorter intubation sequence, acceptable intubation conditions, and a similar level of complications compared to those of conventional RSI with succinylcholine.

참고문헌 (Reference)

1 Scheller MS, "Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil" 75 : 788-793, 1992

2 Sieber TJ, "Tracheal intubation with rocuronium using the "timing principle"" 86 : 1137-1140, 1998

3 Davidson JA, "Tracheal intubation after induction of anaesthesia with propofol, alfentanil and i.v. lignocaine" 70 : 163-166, 1993

4 Marsch SC, "Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial" 15 : R199-, 2011

5 Nelson JM, "Rocuronium versus succinylcholine for rapid-sequence induction using a variation of the timing principle" 9 : 317-320, 1997

6 Sluga M, "Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases" 101 : 1356-1361, 2005

7 Perry JJ, "Rocuronium versus succinylcholine for rapid sequence induction intubation" CD002788-, 2008

8 Mencke T, "Rocuronium is not associated with more vocal cord injuries than succinylcholine after rapid-sequence induction: a randomized, prospective, controlled trial" 102 : 943-949, 2006

9 El-Orbany M, "Rapid sequence induction and intubation: current controversy" 110 : 1318-1325, 2010

10 Suzuki T, "Effectiveness of the timing principle with high-dose rocuronium during rapid sequence induction with lidocaine, remifentanil and propofol" 24 : 177-181, 2010

11 Benumof JL, "Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine" 87 : 979-982, 1997