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Comparision of High Dose Rocuronium with Succinylcholine for Intubation

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Comparision of High Dose Rocuronium with Succinylcholine for Intubation Original Article Indian Journal of Anaesthesia and Analgesia313 Volume 4 Number 2, April ­ June 2017 (Part–1) DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4217.22 Comparision of High Dose Rocuronium with Succinylcholine for Intubation Lata D. Shetty*, Bahubali D. Gane**, Akash Gadgade*** Abstract all patients of group B received Higher dose (1.2 mg) of rocuronium (1.2 mg/kg). After Rocuronium would be suitable giving the muscle relaxant, for rapid intubation conditions. Context: Succinylcholine has patient was ventilated with Keywords: Succinylcholine; extremely rapid onset of action oxygen, nitrous oxide, and Rocuronium; Intubation; and its shorter duration of action isoflurane for 90 seconds. The Haemodynamic Changes. make it the ideal muscle relaxant intubating condition is for rapid sequence intubation. evaluated and scored Because of these adverse effects according to the four step scale Introduction and risks associated with proposed by Goldberg and succinylcholine, extensive colleagues. Statistical Analysis laboratory research has been Used: Analysed using Microsoft Tracheal intubation is one of undertaken to synthesize a Excel 2010 and SPSS (Version the common procedure performed nondepolarising neuromuscular 19) software. All data on during general anesthesia. It is blocking agent. Rocuronium a categorical variables were also a life saving intervention that structural analogue of presented as frequencies and is performed in the emergency vecuronium was recently percentages. Chi square test department. Neuromuscular synthesized and has been was used to compare the blocking agents like demonstrated to have fastest frequencies and percentages. succinylcholine, pancuronium, onset of action compared to any All the statistical analysis were vecuronium, atracurium, nondepolarizing neuromuscular carried out at 5% level of rocuronium are used to achieve blocking agent. Aims: To significance and p value <0.05 muscle relaxation for tracheal compare the two muscle was considered significant. Chi intubation. Succinylcholine has relaxants i.e., succinylcholine square test was used to extremely rapid onset of action and rocuronium on tracheal compare the frequencies and intubating conditions. Settings percentages. Results: There were Author’s Affiliation: and Design: This study was a no statistically significant *Assistant Professor, Department of double blinded, randomized, changes in heart rate, systolic Anesthesiology, Khaja Banda controlled trial, carried out at and diastolic between the Nawaz Institute of Medical Sciences tertiary care centre in India Gulbarga, Karnataka, India. succinylcholine group (A) and **Assistant Professor, Department between March 2014 and June rocuronium group (B) at of Paediatrics, Sri Venkateshwara 2016. The sample size for this various time intervals. In Medical College, Pondicherry. study was calculated to be 45 in succinylcholine group (A) ***Tutor, Department of each group. Methods and Pharmacology, Belgaum Institute of 95.5% had excellent intubating Medical Sciences, Belgaum, Material: All patients included conditions at 90 seconds. In Karnataka. in the study were premedicated rocuronium group (B) 93.3% of with inj.glycopyrolate 0.2mg patients had excellent Corresponding Author: intramuscularly ½ hr before Lata D. Shetty, Assistant Professor, intubating conditions at 90 Department of Anesthesiology, surgery. General anaesthesia seconds. All the patients of Khaja Banda Nawaz Institute of was induced with propofol rocuranium group could be Medical Sciences, Gulbarga, 2mg/kg and fentanyl 2mg/kg intubated at 90 seconds. Karnataka, India, 585102. E­mail: [email protected] intravenously. All Group Conclusion: Rocuronium does A patients received not produce significant Received on 13.02.2017 succinylcholine (2mg/kg) and haemodynamic changes. Accepted on 15.02.2017 ©RedIndian Flower Journal Publication of Anaesthesia Pvt.Ltd and Analgesia / Volume 4 Number 2 / April - June 2017 (Part–1) 314 Lata D. Shetty et. al. / Comparision of High Dose Rocuronium with Succinylcholine for Intubation and its shorter duration of action (less than 2 to 3 study were premedicated with inj.glycopyrolate minutes) make it the ideal muscle relaxant for rapid 0.2mg intramuscularly ½ hr before surgery. sequence intubation [1]. It can cause fasciculation, After obtaining informed written consent from which may lead gastric regurgitation and aspiration. patients fulfilling the inclusion criteria, allocation of It can increase intracranial and intraocular pressure. participants to specific treatment groups (Group A Potentially life­threatening effects like hyperkalemia and Group B) was carried out using a computer­ which may precipitate severe dysarrythmias and generated sequence of random numbers. Allocation cardiac arrest are seen with this drug. Because of these concealment was done using sealed envelopes. adverse effects and risks associated with Anesthetist who was not involved in the study did succinylcholine, extensive laboratory research has random number generation, concealment and been undertaken to synthesize a nondepolarising assignment of intervention. Before induction vital neuromuscular blocking agent with a speed of onset signs were recorded. ECG, peripheral oxygen comparable to succinylcholine but with none of its saturation (pulse oximetry), pulse rate, non­invasive adverse effects [2]. Fazadinium bromide (ah8165) arterial blood pressure was monitored throughout with onset of paralysis within two minutes was the procedure. General anaesthesia was induced with introduced however fazadinium has longer duration propofol 2mg/kg and fentanyl 2mg/kg of action (more than 50 minutes) and was associated intravenously. All Group A patients received with significant tachycardia and hypotension [2­4]. succinylcholine (2mg/kg) and all patients of group B Subsequently Pancuronium, Pipecuronium, received rocuronium (1.2 mg/kg). After giving the Doxacuronium, Atracurium were introduced but the muscle relaxant, patient was ventilated with oxygen, onset of action was not rapid. Vecuronium was tried nitrous oxide, and isoflurane for 90 seconds. At the for rapid sequence induction with high doses of same time, the anesthetist blinded by the type of the 0.15mg/kg but it did not have faster onset of action relaxant used did laryngoscopy. The intubating as compared to succinylcholine [2]. Rocuronium a condition is evaluated and scored according to the structural analogue of vecuronium was recently four step scale proposed by Goldberg and colleagues synthesized and has been demonstrated to have [6]. fastest onset of action compared to any Following intubation, anaesthesia was maintained nondepolarizing neuromuscular blocking agent [4,5]. with oxygen, nitrous oxide and 0.2 ­ 0.5 % isoflurane. Its onset time approaches to that of succinylcholine. Patients were given intermittent positive pressure It virtually has no clinically significant cardiovascular ventilation. Throughout the procedure changes in effects and it does not cause hyperkalemia. Our heart rate, blood pressure, were measured. Heart rate purpose of study is to compare the two muscle and blood pressure were recorded before induction relaxants i.e., succinylcholine and rocuronium on (pre induction); at direct laryngoscopy (0 minute); 1 tracheal intubating conditions. minute after laryngoscopy; 5 minute after laryngoscopy; 10 minute after laryngoscopy. Materials and Methods The data was analysed using Microsoft Excel 2010 and SPSS (Version 19) software. All data on categorical variables were presented as frequencies This study was conducted with aim to compare and percentages. Chi square test was used to compare and evaluate the tracheal intubating conditions of the frequencies and percentages. All the statistical succinylcholine and rocuronium. This study was a analysis were carried out at 5% level of significance double blinded, randomized, controlled trial, carried and p value <0.05 was considered significant. Chi out at tertiary care centre in India between March square test was used to compare the frequencies and 2014 and June 2016. This trial was approved by percentages. All the statistical analysis were carried institute ethical committee. The sample size for this out at 5% level of significance and p value <0.05 was study was calculated to be 45 in each group. Patients considered significant. aged between 18 to 60 years undergoing surgical procedure with ASA physical status grade I – II and Mallampatti class I – II airway were included in the Results study. Patients having neuromuscular disease, receiving medications known to influence neuromuscular function., with cardiac, renal, hepatic This is a prospective study comprising of two and metabolic diseases and Mallampatti III – IV were groups, with sample size of 45 cases in each group. excluded from study. All patients included in the The haemodynamic changes up to 20 minutes and Indian Journal of Anaesthesia and Analgesia / Volume 4 Number 2 / April - June 2017 (Part–1) Lata D. Shetty et. al. / Comparision of High Dose Rocuronium with Succinylcholine for Intubation 315 intubation condition were studied. There is no pressure at 5, 10, 20 minutes. In the rocuronium group statistically significant heart rate variation within the (B) there was fall in systolic blood pressure from succinylcholine group. In the rocuronium group, after 122.69 ± 18.43 at pre induction to 115.73 ± 20.56 at intubation the heart rate is significantly increased intubation. This was followed by fall in systolic blood from the mean of 81.50
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