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Background. Succinylcholine and rocuronium are the predominant neuromuscular blocking agents (NMBAs) used for rapid sequence intubation (RSI) in the emergency department (ED). Prior studies have found reduced first‐attempt intubation success (FAIS) with rocuronium compared to succinylcholine. Recent large registry data have shown no difference in intubating conditions or FAIS. Objectives. The objective of this study was to compare FAIS rates for rocuronium and succinylcholine when used for RSI in a high‐acuity academic ED. Methods. This was a single‐center retrospective study. Patients were included if they received either succinylcholine or rocuronium for RSI in the ED from January 2016 to August 2020. The primary endpoint was FAIS. Subgroup analyses were performed evaluating the impact of weight‐based dosing on FAIS for each agent, and multivariate analysis was conducted to evaluate the impact of baseline characteristics on the primary outcome. Results. There were 448 patients who received rocuronium and 183 patients who received succinylcholine. No difference was observed in unadjusted FAIS between patients receiving rocuronium (median weight‐based dose: 1.22 mg/kg) or succinylcholine (median weight‐based dose: 1.43 mg/kg) (361 (80.6%) vs. 150 (82.0%), p = 0.69). There were no differences in FAIS between the weight‐based dose categories for rocuronium and for succinylcholine. Conclusions. These findings were consistent with those from recent studies indicating no difference in FAIS between rocuronium and succinylcholine, although the median dose of rocuronium used in this study was higher than traditionally recommended. Larger prospective studies are warranted to further evaluate the effect of weight‐based paralytic dosing on FAIS. [ABSTRACT FROM AUTHOR]

Rapid sequence intubation (RSI) is frequently performed by emergency medical services (EMS). We investigated the relationship between succinylcholine and rocuronium use and time until first laryngoscopy attempt, first-pass success, and Cormack-Lehane (CL) grades. We included adult patients for whom prehospital RSI was attempted from July 2015 through June 2022 in a retrospective, observational study with pre-post analysis. Timing was verified using recorded defibrillator audio in addition to review of continuous ECG, pulse oximetry, and end-tidal carbon dioxide waveforms. Our primary exposure was neuromuscular blocking agent (NMBA) used, either rocuronium or succinylcholine. Our prespecified primary outcome was the first attempt Cormack-Lehane view. Key secondary outcomes were first laryngoscopy attempt success rate, timing from NMBA administration to first attempt, number of attempts, and hypoxemic events. Of 5,179 patients in the EMS airway registry, 1,475 adults received an NMBA while not in cardiac arrest. Cormack-Lehane grades for succinylcholine and rocuronium were similar: grade I (64%, 59% [95% CI 0.64–1.09]), grade II (16%, 21%), grade III (18%, 16%), grade IV (3%, 3%). The median interval from NMBA administration to start of the first attempt was 57 s for succinylcholine and 83 s for rocuronium (mean difference 28 [95% CI 20–36] seconds). First attempt success was 84% for succinylcholine and 83% for rocuronium. Hypoxemic events were present in 25% of succinylcholine cases and 23% of rocuronium cases. Prehospital use of either rocuronium or succinylcholine is associated with similar Cormack-Lehane grades, first-pass success rates, and rates of peri-intubation hypoxemia. [ABSTRACT FROM AUTHOR]

INTRODUCTION The goal of rapid sequence intubation is to secure the patients airway smoothly and quickly, minimizing the chances of regurgitation and aspiration of gastric contents. Traditionally succinylcholine chloride has been the neuromuscular blocking drug of choice for use in rapid sequence intubation because of its rapid onset of action and profound relaxation. Succinylcholine chloride remains unsurpassed in providing ideal intubating conditions. However the use of succinylcholine chloride is associated with many side effects like muscle pain, bradycardia, hyperkalaemia and rise in intragastric and intraocular pressure. Rocuronium bromide is the only drug currently available which has the rapidity of onset of action like succinylcholine chloride. Hence the present study was undertaken to compare rocuronium bromide with succinylcholine chloride for use during rapid sequence intubation in adult patients METHODOLOGY The study population consisted of 90 patients aged between 18-60 years posted for various elective surgeries requiring general anaesthesia at Sri Venkateswara Medical College, Tirupati study population was randomly divided into 2 groups with 30 patients in each sub group. 1. Group I: Intubated with succinylcholine chloride 1 mg kg-1 (n = 30) 2. Group II: Intubated with rocuronium bromide 0.9 mg kg-1 (n = 30) Intubating conditions were assessed at 60 seconds based on the scale adopted by Toni Magorian et al. 1993. The haemodynamic parameters in the present study were compared using p-value obtained from student t-test. RESULTS It was noted that succinylcholine chloride 1 mg kg-1 body weight produced excellent intubating conditions in all patients. Rocuronium bromide 0.9 mg kg-1 body weight produced excellent intubating conditions in 96.67% of patients, which was comparable to that of succinylcholine chloride. INTERPETATION AND CONCLUSION Thus, from the present study, it is clear that succinylcholine chloride is the drug of choice for rapid sequence intubation. Rocuronium bromide is a safe alternative to succinylcholine chloride in conditions where succinylcholine chloride is contraindicated and in whom there no anticipated difficult airway. [ABSTRACT FROM AUTHOR]

Background: Rocuronium bromide is a new amino steroidal neuromuscular blocking agent which is structurally related to vecuronium and its onset time and intubating conditions are comparable with succinylcholine and without the undesirable side effects. Aims and Objectives: This study was planned to evaluate the ideal intubating dose of rocuronium bromide by comparing intubating conditions achieved by its different doses of rocuronium bromide and to consider rocuronium as an ideal intubating muscle relaxing agent, in place of succinylcholine chloride for elective long surgeries. Materials and Methods: This study was conducted on 120 patients who fulfilled the eligibility criteria. These patients were randomized into four groups of 30 each by block randomization technique. Each group received rocuronium bromide 0.6 mg/kg, 0.9 mg/kg, 1.2 mg/kg, and succinylcholine chloride 1 mg/kg, respectively. Results: Out of all the three doses of rocuronium bromide 0.9 mg/kg produced a similar intubating condition as succinylcholine chloride in the dose of 1 mg/kg without undue prolongation of the neuromuscular blockade. Conclusion: Rocuronium bromide can be used as an alternative to succinylcholine as an ideal intubating muscle relaxing agent. [ABSTRACT FROM AUTHOR]

Introduction: Agitation immediately after EA operation is one of the common problems during recovery, especially in children. In general, agitation is defined as a set of physical symptoms or emotional distress that includes the following symptoms alone or together: crying, restlessness, clutching, demonstrations, verbal kicking, and purposeful or purposeless behaviors that may have a logical connection. Method: In this study, 60 patients in the age range of 20 to 50 years who were in ASA I and II categories were subjected to tracheal intubation in two groups by rapid sequence induction method. The first group received 3 μg/kg of fentanyl and 0.5 mg/kg of lidocaine for premedication and were given induction with 1 mg/kg of succinylcholine and 5 mg/kg of nesdonal. The second group received 3 μg/kg of fentanyl and 0.5 mg/kg of lidocaine for premedication and were given induction with 0.6 mg/kg of rocuronium and 5 mg/kg of nesdonal. After surgery, the incidence, intensity and duration of agitation when the patient woke up in both groups was recorded by a physician based on Riker's criteria. Also, the occurrence of myalgia and its persistence from one to 24 hours after the operation were assessed. Results: According to the results of this clinical trial, succinylcholine and rocuronium were not significantly different from each other in terms of the occurrence of agitation, its intensity and duration, but based on the results of the odds ratio, the probability that in patients who took rocuronium they found that agitation is 0.6 times less than the patients who received succinylcholine. Logistic analysis of the data also showed that in patients who received succinylcholine, the probability of agitation being more severe is 2.47 times higher than in patients who received rocuronium. The duration of agitation in patients receiving succinylcholine was also higher than in patients receiving rocuronium. In terms of the incidence and severity of myalgia, there was no significant difference in the people who received rocuronium or succinylcholine, however, a total of 50% of the patients showed agitation symptoms, showed myalgia, of which 16.6% were related to the people who received rocuronium and 33.3% were related to patients who received succinylcholine. The results of the myalgia odds ratio also showed that the probability of myalgia symptoms being observed in patients who received rocuronium is 0.5 times lower than in patients who received succinylcholine. Conclusion: In aggregate, the results of this trial showed that rocuronium can be a suitable alternative to succinylcholine in applications outside the operating room. [ABSTRACT FROM AUTHOR]

Introduction: Succinylcholine is a muscle relaxant of choice for paediatric intubation due to its fast onset and ultrashort duration of action but it is associated with unwanted sideeffects. Rocuronium bromide can be used alternatively to avoid those unwanted side-effects because of its fast onset and intermediate duration of action. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations, and complications to get a better alternative dose of rocuronium bromide in children undergoing elective surgeries. Materials and Methods: The present randomised, doubleblinded clinical trial study was conducted in the Department of Anaesthesiology, Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India from January 2021 to October 2022. Ninety American Society of Anaesthesiology (ASA) Grade-I-II children of both sexes of 1-10 years age, undergoing elective surgery were equally divided into three groups. Group-R9 (n=30) and Group-R12 (n=30) received rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively while Group-S (n=30) received succinylcholine 1.5 mg/kg. Comparative evaluation of intubating conditions was done around 60 seconds in all three groups and duration of action, haemodynamic variations, and complications were noted. All data were entered in a microsoft excel sheet and results were expressed as percentages, mean Standard Deviation (SD), chi-square test, and Analysis of Variance (ANOVA) test where the difference was considered statistically significant if the p-value <0.05 by using the software Statistical Package for the Social Sciences version 11.0 (SPSS version 11.0). Results: Rocuronium bromide 1.2 mg/kg and succinylcholine 1.5 mg/kg provided excellent intubating conditions in 96.7% children and good intubating conditions in 3.3% children in both groups while rocuronium bromide 0.9 mg/kg provided excellent intubation conditions in 83.3% of children and good intubating conditions in 16.7% of children There was a significant difference present in intubation scores between three groups (p=0.01). The duration of action was longer with rocuronium bromide 1.2 mg/kg (38.93±4.323 min) as compared to rocuronium bromide 0.9 mg/kg (26.07±2.791 min) while it was shortest with succinylcholine 1.5 mg/kg (6.00±1.74 min). Adverse effects like fasciculations were only found in children (n=30) receiving succinylcholine (p=0.01) but not in rocuronium bromide groups. Conclusion: Rocuronium bromide 1.2 mg/kg gives the same intubating conditions as succinylcholine 1.5 mg/kg with good haemodynamic stability and no side-effects but the duration of action was longer with rocuronium bromide 1.2 mg/kg as compared to rocuronium bromide 0.9 mg/kg. So, to avoid unwanted sideeffects of succinylcholine in children, rocuronium bromide 1.2 mg/kg can be used as an alternative to succinylcholine 1.5 mg/kg in children undergoing elective surgeries where early return of spontaneous recovery is not needed. [ABSTRACT FROM AUTHOR]

Aim and Objective: The purpose of this study was to compare the duration of action of Rocuronium and Suxamethonium during elective thyroidectomy. Methodology : This double-blind experimental study included 60 patients ranging in age from 18 to 60 years old who underwent elective thyroidectomy under general anaesthesia after approval from the Institutional Ethics Committee and written patient consent Result: The Duration of action was comparable between the groups with statistically significant difference (p value is less than 0.05). For analysis of difference in duration of action "t" test was used. P value is less than 0.05, (p=0.000) indicating that highly significant difference between the groups in the duration of action. Conclusion: The study found that Rocuronium has a significantly longer duration of action than Suxamethonium. [ABSTRACT FROM AUTHOR]

Background: Suxamethonium, a depolarizing neuromuscular agent, was introduced in 1952 and since then has been used for tracheal intubation. It was favoured for its rapid onset and ultra-short duration of action but has numerous side effects, especially cardiovascular. So agents with low potency and shorter duration of action were developed, and in 1995, Rocuronium was introduced, which is a non-depolarizing agent and has the fastest onset of action. Aim and objective: The aim of the study was to compare the intubating conditions at 60 seconds after giving Rocuronium 0.6 mg/kg and Suxamethonium 1 mg/kg intravenously. Methods: In this clinical trial, a total of 60 patients were enrolled. Patients were divided into groups A and B. Group A received Rocuronium 0.6 mg/kg intravenously, and Group B received suxamethonium 1 mg/kg, and all were intubated after 1 minute. Intubation conditions were noted and scored according to a modification of the Kreig et al.,. method. Results: It was observed that intubation conditions were excellent in both groups; there was tachycardia associated with the Rocuronium group, and blood pressure was higher in the Suxamethonium group. Conclusion: Rocuronium can be acceptable for intubation instead of Suxamethonium, except in conditions anticipating difficult intubation. [ABSTRACT FROM AUTHOR]

Background and aims Cisatracurium has many advantages over other nondepolarizing muscle relaxants; however, for rapid intubation, rocuronium is the preferred drug in lieu of succinylcholine. The aim of this study was to compare the onset time and intubating conditions at 90 s using 0.3 mg/kg cisatracurium (6x ED95) versus 1.2 mg/kg rocuronium (4x ED95). Material and methods The study was conducted at a tertiary care hospital as a randomized double-blind prospective study after obtaining the ethical committee clearance. A total of 60 patients were randomly assigned to receive 1.2 mg/kg rocuronium (4x ED95) or 0.3 mg/kg cisatracurium (6x ED95) after premedication with fentanyl-midazolam and induction with propofol-sevoflurane. Laryngoscopy and intubation were done at 90 s. Primary outcomes assessed were laryngoscopy and intubation conditions and onset times. The Student t test was used to compare prospective, repeated measures. χ² test was used to test the significance of difference for qualitative variables. Results The onset of action of the muscle relaxant was predicted by measuring train-of-four ratio and was found to be significantly longer in the cisatracurium group (149.50 ±25.064 s) than in the rocuronium group (101±s) (P<0.05). Although the intubating conditions were better in the rocuronium group, cisatracurium also provided good to excellent intubation conditions at 90 s. Conclusion Cisatracurium can be used to intubate the trachea at 90 s at a dose of 0.3 mg/kg in patients premedicated with fentanyl-midazolam and induced with propofol-sevoflurane, while maintaining hemodynamic stability, without increasing the incidence of adverse effects. [ABSTRACT FROM AUTHOR]

Introduction: Succinylcholine is the best agent for providing ideal intubating condition. Muscle fasciculation is common after succinylcholine administration and causes postoperative myalgia. Pretreatment with non depolarising muscle relaxant decreases fasciculation and myalgia after succinylcholine administration. Aim: To compare the efficacy between cisatracurium and rocuronium in preventing succinylcholine induced fasciculation in patients undergoing general anaesthesia and determining association between fasciculation and myalgia after succinylcholine use. Materials and Methods: The present study was a hospital-based, randomised, double-blinded clinical study conducted from January 2020 to July 2020. The study included 64 patients of American Society of Anaesthesiologists (ASA) grade I and II undergoing surgery under general anaesthesia which were randomly allocated in two groups. Group 1 (N=32) received intravenous (i.v.) cisatracurium (0.01 mg/kg) and Group 2 (N=32) received i.v. rocuronium (0.06 mg/kg) as precurarising agent, three minutes before i.v. succinylcholine (1.5 mg/kg) administration. Incidence and intensity of fasciculation after succinylcholine injection were observed using a 4 point scale. Haemodynamic parameters were compared by measuring Mean Arterial Pressure (MAP) and Heart Rate (HR) before and after intubation. Patients were followed-up in Post Anesthesia Care Unit (PACU) on postoperative day 1 (POD1) for myalgia. Observations in two groups were analysed using standard statistical test. Results: Fasciculation was significantly lower in Group 2 (mean 0.2187±0.4200) than Group 1 (mean 1.125±0.833, p<0.001). A significant association was found between fasciculation after succinylcholine injection and postoperative myalgia (p-value=0.007). Group 2 had less incidence of myalgia than Group 1. However, the difference was not statistically significant. Conclusion: Rocuronium was more efficacious than cisatracurium in preventing succinylcholine induced fasciculation and rocuronium was more effective in preventing succinylcholine-related postoperative myalgia. [ABSTRACT FROM AUTHOR]

Background: Succinylcholine with quick onset, ultra short duration of action, and complete predictable paralysis has been the best drug for endotracheal intubation but the occurrence of side effects such as muscle fasciculations, postoperative myalgia, rise in serum potassium levels and myoglobinuria limits its use in the full stomach, burns, massive trauma, metabolic acidosis, and few myopathies. For attenuation of these effects, many drugs have been studied but pre-treatment with non-depolarizing muscle relaxant found to be successful. Aims and Objectives: This study was designed to assess the effect of Rocuronium and Vecuronium pre-treatment on post-succinylcholine fasciculations, rise in serum potassium levels, and postoperative myalgia. Materials and Methods: 100 patients between the age of 20–50 years of either sex (American Society of Anaesthesiologists grade I and II) undergoing general anesthesia for various surgical procedures were randomly allocated into two groups according to pre-treatment with Rocuronium (Group R) and Vecuronium (Group V) before Succinylcholine administration. After Succinylcholine administration severity of fasciculations, rise in serum potassium after 5 min and myalgia on postoperative days 1, 2, and 3 were recorded. Results: About 74% patients had no fasciculation in Group R as compared to 36% in group V. Statistically insignificant (P>0.05) rise in serum potassium level was observed in both groups. Higher number of patients had mild-to-moderate degree of myalgia with Vecuronium on postoperative days 2 and 3. Conclusion: Pre-treatment with Rocuronium before Succinylcholine provided better attenuation of post-succinylcholine muscle fasciculations, postoperative myalgia with statistically insignificant rise in serum potassium levels. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to evaluate first attempt intubation failure rate, its associated factors, and its related complications in out-of-hospital emergency setting, when emergency physicians perform standardized airway management using rapid sequence intubation in adult patients. Material and methods: The present study was a substudy of the Succinylcholine versus Rocuronium for out-of-hospital Emergency Intubation (CURASMUR) Trial, which compared Succinylcholine and Rocuronium used for Rapid sequence intubation. First attempt Intubation failure rate and early intubation related complications were recorded. We used multivariable logistic regression analysis to determine first intubation failure associated factors. Results: A total of 1230 patients were included with mean age of 55.9 +/- 19 years. First attempt intubation failure was recorded in 285 (23.2%) patients. The occurrence of a first attempt intubation failure was independently associated with history of ear, nose, and throat neoplasia (OR 2.20, CI 95% 1.06–4.60). Early intubation related complications were more frequent in case of first attempt intubation failure: 80 of 285 (28.4%) in patients with first attempt intubation failure and 185 of 945 (19.6%) in patients with successful first attempt intubation [OR 1.44; CI 95%, 1.11–1.87]. Conclusion: Based on a large multicenter study on out-of-hospital tracheal intubation of adult patients, we found that first attempt intubation failure rate was high and that history of ear, nose, and throat (ENT) neoplasia was an independent associated factor. Failure in first intubation attempt was associated with significantly more intubation related complications. [ABSTRACT FROM AUTHOR]

Background: Rapid sequence induction is a well-established anesthetic procedure used in patients with a high risk of gastric aspiration. Suxamethonium has been the drug of choice; however, it carries potential risks and sometimes fatal outcomes. The aim of our study was to compare rocuronium after pretreatment with dexmedetomidine, to suxamethonium in providing excellent intubating conditions in rapid sequence induction in adults. Patients were randomly allocated to one of two groups, of 120 each. Control group (SS), patients received pretreatment with 10 ml 0.9% saline over 10 min and suxamethonium 1mg/kg. Experimental group (DR), received pretreatment with dexmedetomidine 1 μg/kg in 10 ml 0.9% saline over 10 min and rocuronium 0.6 mg/kg. Our primary endpoint was the number of patients who scored "excellent" on intubation conditions score, while secondary outcomes were hemodynamics and adverse events. Results: The rate of excellent intubating conditions in the DR group 46% was insignificantly less (P value = 0.548) than that of the SS group 49% (relative risk (RR) of DR compared to SS = 1.04, with a confidence interval (CI) of 0.91–1.48. The percentage of patients with adverse events in the SS group was (30%) nearly more than twofold higher than that of the DR group (11%). A significant difference (P value = 0.016) in the incidence of excellent intubating conditions was higher in the female gender 59% compared to the male gender 38% (adjusted RR = 0.98, with a confidence interval of 0.79–1.1). Conclusion: A combination of dexmedetomidine 1μg/kg and standard intubating dose of rocuronium 0.6 mg/kg provided comparable endotracheal intubation conditions to suxamethonium 1 mg/kg during RSI and might be used as an alternative to suxamethonium in situations where suxamethonium is contraindicated. Trial registration: ClinicalTrials.gov Identifier: NCT04709315 [ABSTRACT FROM AUTHOR]

Background: Succinylcholine has been the main neuromuscular blocking agent for the endotracheal intubation in rapid sequence induction with some adverse effects. This study was conducted to find a better alternate drug with minimal adverse effects and easy for intubations. Thus, our study aimed to compare the onset time, duration of action, intubating condition and hemodynamic effect of rocuronium bromide at the dose of 0.8 mg/kg and Succinylcholine at the dose of 1.5 mg/kg. Materials and methods: A double blinded randomized control study was conducted among 60 patients undergoing surgery each groups having 30 patients, Duration of action, Hemodynamic parameters, and intubating conditions were assessed after administering drugs in each group. Appropriate statistical tests were applied P value < 0.05 was considered to be significant Results: The mean of onset of action of succinylcholine is significantly shorter than that of rocuronium (48.07 ± 4.04 Vs 74.4 ± 9.1); and duration of action succinylcholine is significantly shorter than that of the rocuronium (3.85 ± 0.33 Vs 44.4 ± 4.7). Both the drugs significantly elevated mean Heart rate, Systolic Blood Pressure, Diastolic Blood pressure, MAP from intubation to subsequent intervals. Conclusion: The rocuronium bromide (0.8 mg/kg) has longer duration of action and slower onset of action than succinylcholine (1.5 mg/kg) with excellent intubating condition and minimal alteration in hemodynamic profile. Hence rocuronium bromide (0.8 mg/kg) can be used as an alternative to Succinylcholine (1.5 mg/kg) in selected situations. [ABSTRACT FROM AUTHOR]

Aim: The skeletal muscle Cl− channels, the ClC‐1 channels, stabilize the resting membrane potential and dampen muscle fibre excitability. This study explored whether ClC‐1 inhibition can recover nerve‐stimulated force in isolated muscle under conditions of compromised neuromuscular transmission akin to disorders of myasthenia gravis and Lambert–Eaton syndrome. Methods: Nerve‐muscle preparations were isolated from rats. Preparations were exposed to pre‐or post‐synaptic inhibitors (ω‐agatoxin, elevated extracellular Mg2+, α‐bungarotoxin or tubocurarine). The potential of ClC‐1 inhibition (9‐AC or reduced extracellular Cl−) to recover nerve‐stimulated force under these conditions was assessed. Results: ClC‐1 inhibition recovered force in both slow‐twitch soleus and fast‐twitch EDL muscles exposed to 0.2 µmol/L tubocurarine or 3.5 mmol/L Mg2+. Similarly, ClC‐1 inhibition recovered force in soleus muscles exposed to α‐bungarotoxin or ω‐agatoxin. Moreover, the concentrations of tubocurarine and Mg2+ required for reducing force to 50% rose from 0.14 ± 0.02 µmol/L and 4.2 ± 0.2 mmol/L in control muscles to 0.45 ± 0.03 µmol/L and 4.7 ± 0.3 mmol/L in muscles with 9‐AC respectively (P <.05, paired T test). Inhibition of acetylcholinesterase (neostigmine) and inhibition of voltage‐gated K+ channels (4‐AP) relieve symptoms in myasthenia gravis and Lambert–Eaton syndrome, respectively. Neostigmine and 9‐AC additively increased the tubocurarine concentration required to reduce nerve‐stimulated force to 50% (0.56 ± 0.05 µmol/L with 9‐AC and neostigmine) and, similarly, 4‐AP and 9‐AC additively increased the Mg2+ concentration required to reduce nerve‐stimulated force to 50% (6.5 ± 0.2 mmol/L with 9‐AC and 4‐AP). Conclusion: This study shows that ClC‐1 inhibition can improve neuromuscular function in pharmacological models of compromised neuromuscular transmission. [ABSTRACT FROM AUTHOR]

Purpose Rocuronium Bromide Intravenous Solution® (Maruishi Pharmaceutical Co., Ltd, Osaka, Japan) is a newly developed generic drug and we have noticed that compared with conventional rocuronium formulations [e.g. Esmeron (Eslax), MSD Co. Ltd., Tokyo, Japan], rocuronium Maruishi appeared to cause less pain or withdrawal movement. The aim of this study was to assess the hypothesis that the injection of rocuronium Maruishi causes less body movement than rocuronium MSD does, during rapid-sequence induction of anesthesia. Methods Sixty patients were allocated randomly to one of two groups. In one group, rocuronium MSD was used and in the other group, rocuronium Maruishi was used. After induction of general anesthesia, a test drug (containing rocuronium) 0.9 mg/kg was injected. Patient's withdrawal movement was graded with the scale. Primary outcome measure was the incidence of moderate or severe movement after the injection of rocuronium. Secondary outcome measure was the degree of movement between the groups. Results Moderate or severe withdrawal movement was observed after the injection of rocuronium MSD in 11 of 30 patients (37%) and after the injection of rocuronium Maruishi in 3 of 30 patients (10%). There was a significant difference in the incidence between the groups (P = 0.013, 95% CI for difference 26-28%). The degree of movement was also significantly greater for rocuronium MSD than for rocuronium Maruishi (P = 0.015). Conclusion Compared with rocuronium MSD, rocuronium Maruishi is more suitable than conventional rocuronium formulations, for rapid-sequence induction of anesthesia., Author(s): Masato Tachikawa [sup.1] , Takashi Asai [sup.1] , Yasuhisa Okuda [sup.1] Author Affiliations: (Aff1) grid.255137.7, 0000 0001 0702 8004, Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, , [...]

Background - Succinylcholine is a short-acting myorelaxant used in rapid sequence intubation, in obese patients and short operations. The need for prolonged myorelaxation requires safety precautions described in this case report. Patient - 34-year-old, morbidly obese man with OSA and PONV admitted for an elective deviated septum surgery. Anaesthesia - Standard monitoring + TOF Scan. Dexamethasone, lidocaine, fentanyl, propofol and succinylcholine were used for induction. After 3 minutes a 50 mg bolus of rocuronium was given. By the end of surgery there were no TOF responses. Return of neuromuscular conduction was observed after 30 minutes of the end of surgery and after 10 doses of 200 mg of sugammadex. Discussion and conclusions - Succinylcholine makes nicotine receptors more sensitive to non-depolarizing agents, which is why their dose should be significantly lower when used consecutively. When diagnosing prolonged myorelaxation hypothermia, inhalational anaesthetics, medications (eg. magnesium, lidocaine) and positioning of neuromuscular monitoring electrodes should be considered. [ABSTRACT FROM AUTHOR]

BACKGROUND: Data are limited regarding current practice and outcomes for emergency department airway management in status asthmaticus. This paper describes the foremost methods and outcomes of airway management in patients in the emergency department who required intubation for status asthmaticus. METHODS: We analyzed all intubations with a primary indication of asthma over a 3-y period (January 1, 2016 to December 31, 2018) using the National Emergency Airway Registry (NEAR), a 25-center, prospective, observational registry of emergency department intubations. We report the incidence of intubations for asthma, methods and medications used, devices used, peri-intubation adverse events, and intubation success and failures using univariate descriptive statistics and cluster-adjusted incidence with 95% CI. RESULTS: A total of 19,071 encounters were recorded during the study period, with 14,517 patients intubated for medical indications. Of those, 173 (1.2%, 95% CI 0.9-1.6) were intubated for asthma. The first-attempt success rate was 90.8% (95% CI 81.9-95.5), and overall intubation success was 100%. Compared to the medical registry as a whole, patients with asthma were more likely to undergo rapid-sequence intubation (96.5% [95% CI 92.9-98.3] vs 80.8% [95% CI 75.1-82.5]), preoxygenation with bi-level positive airway pressure (BPAP) (62.9% [95% CI 49.6-74.6] vs 13.5% (95% CI 10.4-16.9]), and induction with ketamine (51.8% [95% CI 30.6-71.4] vs 11.6% [95% CI 7.6-16.8]). The adverse event rate in the patients with asthma was 12.14% (95% CI 8.1-17.9) compared to 11.93% (95% CI 9.79-14.12) in the medical registry. CONCLUSIONS: Status asthmaticus accounted for about 1% of emergent medical intubations. The majority of patients were intubated using rapid-sequence intubation after preoxygenation with BPAP and induction with ketamine, with the latter 2 practices being much more common for emergent intubations for status asthmaticus than for other medical indications. [ABSTRACT FROM AUTHOR]

Objectives: To compare endotracheal intubating conditions in rapid sequence induction using Suxamethonium and Rocuronium. Study Design: Randomized Controlled Trial. Setting: Allied Hospital Faisalabad. Period: From 02-07-2015 to 01-07-2016. Material & Methods: After taking approval from hospital ethical committee, cases of emergency surgery fulfilling the inclusion criteria were enrolled and informed consent was taken after explaining all the procedure to the patient. All the patients were randomly divided into 2 groups by using computer generated random number table. Both groups were induced with thiopentone sodium 5mg/kg, analgesia was given with nalbuphine 0.1mg/kg. Group A was given Suxamethonium in a dose of 1 mg/kg body weight after induction agent. Group B was given 0.6 mg/kg Rocuronium after induction. Intubation was performed after 60 sec in both groups with cricoid pressure. Anesthesia was maintained with O2/N2O in a ratio of 50:50 and isoflurane (0.6-1.0%) in both groups. Anesthesia was stopped at the end of surgery in all the patients. Results: Mean age of the patients was 40.49+11.47 and 43.43+12.88 years, 51.43% and 45.71% were male while 48.57% and 54.29% were females, Comparison of intubation conditions was recorded as 97.14% excellent and 2.86% good in patients received suxamethonium and 82.86% and 17.14% in Rocuronium Group had good conditions. Conclusion: It was found that Suxamethonium is significantly better when compared to Rocuronium for endotracheal intubation conditions in rapid sequence induction. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Sugammadex allows rapid recovery from rocuronium-induced neuromuscular blockade. Succinylcholine is often used for brief surgeries but is associated with myalgia, headache, histamine release, and increased lactate levels. Thus, we hypothesized that succinylcholine may affect emergence agitation (EA) and compared the effects of succinylcholine and rocuronium-sugammadex on EA in patients undergoing closed reduction of a nasal bone fracture under general anesthesia. Methods: Forty-two patients were prospectively enrolled and allocated randomly to the succinylcholine group (group SC) or the rocuronium-sugammadex group (group RS; each n = 21). Neuromuscular block and its reversal were achieved with succinylcholine and normal saline in group SC, whereas rocuronium and sugammadex were administered in group RS. After surgery, the incidence of EA as a primary outcome, the incidence of dangerous EA, and duration of EA as secondary outcomes were compared. Results: The incidence of EA was higher in group SC than in group RS (90.5% vs. 47.6%, respectively; relative risk [RR] 4.3; 95% confidence interval [CI] 1.2 to 15.7; P =.006). The incidence of dangerous EA increased in group SC compared to group RS (33.3% vs. 4.8%, respectively; RR 2.1; 95% CI 1.3 to 3.4; P =.045). The duration of agitation was longer in group SC than in group RS [106.5 (65.1) vs. 40.4 (26.0) sec; mean difference 66.1 s; 95% CI 31.0 to 101.1; effect size 1.3; P =.001). Conclusion: Succinylcholine increases the incidence, severity, and duration of EA compared to rocuronium-sugammadex in patients undergoing closed reduction of a nasal bone fracture. Trial registration: CRiS Registration number KCT0002673. Initial registration date was 31 January 2018 (Retrospectively registered). [ABSTRACT FROM AUTHOR]

Abstract Rocuronium bromide (ROC) is currently regarded as the 'gold-standard' in emergency medicine and anesthesia. Globally, millions of human beings are daily administered ROC at emergency settings where it is favored among all the neuromuscular blockers, particularly succinylcholine, for both its fast onset of action and short duration. However, it has been reported that 45% of patients in the post-anesthesia care unit are susceptible to residual postoperative paralysis, undesired ventilator effects and incomplete recovery after ROC administration. From an analytical chemistry perspective, direct determination of ROC is a difficult approach due to the complexity in isolation from biological specimens as well as the lack of a sensitive detection techniques and detectable chromophore. This contribution describes the development of a calix[6]arene-based screen-printed electrode (SPE) that is capable of ROC detection in biological samples at the point of care. This fabricated SPE (sensor 1) exhibited superior performance characteristics (slope, LOD and life time) with respect to an ionophore-free liquid-contact electrode, LCE, (sensor 2). The proposed SPE showed a linear response over a concentration from 1 µM to 10 mM, with a Nernstian slope of 57.9 mV/decade and a detection limit of 0.39 µM. Moreover, this sensor showed a considerable selectivity towards ROC in presence of the anticipated interfering ions. To investigate the ability of the SPE to detect ROC in real biological specimens, ROC has been spiked at a concentration comparable to its anticipated level in human plasma (C max ~ 40 µM) and the proposed SPE displayed an excellent platform for therapeutic drug monitoring (TDM) of ROC with respect to UV-spectrophotometry and LC/MS. Finally, the developed SPE was used for the determination of ROC in its commercial pharmaceutical formulation. Graphical abstract fx1 Highlights • Point of care monitoring of rocuronium concentrations in blood exploiting the great opportunities offered by ISEs. • ISEs exceptionally provide straightforward concentration profile of rocuroniumin patient's serum. • ISEs overcome the challenges faced by UV spectrophotometry and LC/MS. • Promising approach to the FDA regulatory requirements for therapeutic drug monitoring. • ISE excels in identification of patients that are susceptible to residual paralysis after ROC administration. [ABSTRACT FROM AUTHOR]

INTRODUCTION Adequate intubating condition is required to avoid airway trauma and adverse sympathetic responses. Though, Succinylcholine is considered as ideal drug, it has many contraindications. In search of alternative, rocuronium is found to have similar responses in higher doses. Therefore, our aim was to compare the effect of different dosages of rocuronium with sucinylcholine for tracheal intubation and the haemodynamic variables. MATERIAL AND METHODS A prospective randomized comparative study was conducted in Universal College of Medical Sciences (UCMS-TH) in 90 (American Society of Anaesthesiologists Physical Status I and II) patients with age between 18 to 60 years scheduled for elective surgeries under general anesthesia. They were divided into 3 groups of 30 each using lottery system. Groups 1 and 2 received intravenous rocuronium 0.6mg/kg and 1mg/kg respectively whereas patients in group 3 received intravenous succinylcholine 1.5mg/kg. Under continuous monitoring, tracheal intubation attempt was done at 60 seconds after the administration of drug and intubating conditions were assessed according to Cooper et al four point scale. RESULTS Only 26.7% of patients in group 1 exhibited excellent intubating condition whereas in groups 2 and 3, excellent intubating condition was exhibited in 100% when muscle relaxant was administered at 60 seconds with highly significant statistical difference between groups 1 and 3 with p value <0.001 without any adverse effects in any of these patients. CONCLUSION This study concluded that intubating response with inj. succinylcholine 1.5mg/kg is similar to rocuronium 1.0mg/kg and is superior to inj rocuronium 0.6mg/kg, for intubating condition at 60 seconds following the drug administration while using Cooper et al. Score. [ABSTRACT FROM AUTHOR]

Background: Endotracheal intubation is required for giving general anesthesia for which adequate muscle relaxation is necessary. Suxamethonium is still used as a relaxant for endotracheal intubation Rocuronium, a nondepolarizing muscle relaxant was compared here for tracheal intubating conditions. Aim of the study: To compare the intubating conditions achieved in patients undergoing elective surgeries under General Anaesthesia with Suxamethonium or Rocuronium in 60 secs and complications in both groups. Materials and methods: This study was conducted in Institute of Anaesthesiology and Critical care at Madras medical college, Chennai during the period 2014 - 15100 patients of ASA I and II were divided randomly into 2 groups undergoing elective surgeries: Group I - Suxamethonium Group II - Rocuronium assessed for intubating conditions after administration of the corresponding drug. Results: The intubating conditions were excellent in group I Suxamethonium as against Group II Rocuronium in 60 secs. According to the cooper scoring system the scores of vocal cord movement in group I (Suxamethonium) was 2.68 (mean) ± 0.471 and in group II (Rocuronium) was 2.34±0.557, the scores of response to intubation in group I (Suxamethonium) was 2.98±0.141 and in group II (Rocuronium) was 2.70±0.463 with better intubating conditions in group I receiving Suxamethonium than Rocuronium. The results were significant with a p-value of<0.05 whereas the scores of jaw relaxation in group I patients (Suxamethonium) was 2.70 (mean)±0.463 and group II patients (Rocuronium) was 2.52±0.544 with better jaw relaxation. Conclusion: Rocuronium can be used as an alternative when suxamethonium is contraindicated for rapid intubation but not if the anticipated difficult airway is present. Rocuronium can be chosen as an alternative to it even in rapid sequence intubation in emergency cases, provided the airway is properly assessed and no anticipated difficult intubation is present. [ABSTRACT FROM AUTHOR]

Objectives: To compare efficacy in term of intubating condition between rocuronium and succinylcholine for rapid sequence induction in cesarean section Methodology: This randomized controlled trial was conducted at anesthesia department of our hospital at Nawabshah from January to December 2016. A total of 124 full term patients with Mallampati I & II and American Society of Anesthesiologists (ASA) physical status class I and II were randomly allocated into two groups. Group A (62 patients), was treated with succinylcholine chloride and Group B (62 patients) received rocuronium bromide for intubation. Intubating conditions were assessed by jaw relaxation, movement of vocal cords and bucking. Efficacy was labeled as ‘Yes’ when score 8 and 9 (excellent) otherwise ‘No’ if score was less than 8 “good and poor”. Blood pressure, heart rate, and SpO2 were monitored. Results: - The average age of the patients was 32.37 ± 1.98 y. Overall rate of excellent intubating conditions at one min was observed in 103 (83.1%) patients, good in 17 (13.7%) and poor in 4 (3.2%). The frequency of clinically acceptable intubating conditions (i.e. excellent) was 87.1% in group A and 79.03% in group B which is not statistically significant. Conclusion: Rocuronium can be safely used for rapid sequence induction in caesarean sections and the intubating conditions are similar to those of succinylcholine. [ABSTRACT FROM AUTHOR]

The article offers information on Rapid sequence intubation (RSI). Topics include procedure to place tube into the trachea facilitated by rapid sedation and paralysis to improve ventilation and oxygenation in emergent, critical care and operating room settings; and commonly used paralytic agents in the emergency department (ED) are succinylcholine (depolarizing) and rocuronium (nondepolarizing).

The article compares the options available for neuromuscular block for rapid sequence induction (RSI). Topics mentioned include the transient increase in serum with suxamethonium, risk factors of RSI in anaesthetic practice, and the reason why non-depolarising neuromuscular blocking agents have been viewed as having no place in RSI.

Background: Succinylcholine remain unsurpassed in providing ideal intubating conditions in the shortest time among all available neuromuscular blocking agents hence is advocated as the drug of choice for rapid sequence endotracheal intubation. Aim: Study compared the effects of succinylcholine and rocuronium bromide on intraocular pressure. Materials and methods: Study was done in 30 samples of ASA physical status 1 and 2 were selected through simple random sampling technique. All patients were scheduled for elective nonopthalmologic surgery for which general endotracheal anesthesia at various intervals at various intervals intraocular pressure changes, pulse rate, systolic and diastolic blood pressure were recorded at each of the above periods. Results: Intraocular pressure was elevated after giving succinylcholine high above the baseline values while in rocuronium group the intraocular pressure reduced below the baseline values. Though in both the groups IOP rose after intubation and decreased after three and five minutes after intubation, in group S it remained above the baseline after five minutes where as in group R it remained below the baseline value. Increasing after intubation nearing baseline value after five minutes after intubation. Conclusion: To conclude rocuronium in a dose of 0.9 mg/kg provides good to excellent intubating conditions comparable to that succinylcholine. It is a suitable agent for tracheal intubation in patients undergoing elective and emergency ophthalmic surgery where raise in intraocular pressure is undesirable. [ABSTRACT FROM AUTHOR]

This systemic review was performed to determine whether rocuronium creates intubating conditions comparable to those of succinylcholine during rapid sequence intubation of the trachea. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 2), MEDLINE (1966 to February Week 2 2015), and EMBASE (1988 to February 14 2015) for any randomised controlled trials or controlled clinical trials that reported intubating conditions comparing rocuronium and succinylcholine for rapid or modified rapid sequence intubation. The dose of rocuronium was at least 0.6 mg.kg-1 and succinylcholine was at least 1 mg.kg-1 . Sixty-six studies were identified and 50 included, representing 4151 participants. Overall, succinylcholine was superior to rocuronium for achieving excellent intubating conditions (risk ratio (95%CI) 0.86 (0.81 to 0.92), n = 4151) and clinically acceptable intubation conditions (risk ratio (95%CI) 0.97 (0.95-0.99), n = 3992). A high incidence of detection bias amongst the trials coupled with significant heterogeneity means that the quality of evidence was moderate for these conclusions. Succinylcholine was more likely to produce excellent intubating conditions when using thiopental as the induction agent: risk ratio (95%CI) 0.81 (0.73-0.88), n = 2302) with or without the use of opioids (risk ratio (95%CI) 0.85 (0.78-0.93), n = 2292 or 0.85 (0.76-0.95), n = 1428). [ABSTRACT FROM AUTHOR]

This study aimed to prospectively evaluate mortality, among other outcomes, following RSI with rocuronium compared to succinylcholine for patients presenting to the emergency department (ED) with acute TBI. The study population consists of adult patients presenting to the ED of a Level 1 Trauma Center with acute TBI who underwent RSI with either succinylcholine or rocuronium. B Introduction: b Acute traumatic brain injury (TBI) often requires rapid sequence intubation (RSI) to protect patients' airways. [Extracted from the article]

Background: Recently, rocuronium with subsequent use of sugammadex was proposed for electroconvulsive therapy (ECT) as an alternative to succinylcholine. Because sugammadex is cleared via the kidney with no metabolism, it is unknown that rocuronium-sugammadex use is safe in hemodialysis patients who received ECT. Case presentation: In this case report, we used rocuronium with subsequent administration of sugammadex in a 69-year-old female, hemodialysis patient, scheduled for ten ECT sessions for severe major depression. In the initial eight sessions, we tested the feasibility of rocuronium-sugammadex use for ECT. During the series of four ECT sessions, we measured plasma concentrations for the sum of sugammadex and sugammadex-rocuronium complex and observed whether possible residual sugammadex affected muscle relaxation during subsequent sessions of ECT. The results showed the feasibility of rocuronium-sugammadex use as muscle relaxants for ECT in patients undergoing hemodialysis. However, an accumulation of sugammadex did occur even after two sessions of hemodialysis, and residual sugammadex decreased the effect of the rocuronium given in the subsequent ECT sessions. Rocuronium-sugammadex was successfully utilized as muscle relaxants for ECT in this patient. Conclusions: Our experience in this case may indicate that if succinylcholine is contraindicated, rocuronium-sugammadex can be an alternative method for muscle relaxation during ECT in patients undergoing hemodialysis. When this rocuronium-sugammadex procedure is used, the effect of residual sugammadex after hemodialysis on the subsequently administered rocuronium should be considered. [ABSTRACT FROM AUTHOR]

Background: The effects of rocuronium at two different doses, that is, 0.6 mg/kg (2 ED95) and 0.9 mg/kg (3 ED95), were compared with succinylcholine (2 mg/kg) when used for endotracheal intubation in adult patients for elective surgeries under general anesthesia. Materials and Methods: Ninety patients were divided into three groups of 30 each. Groups A, B received injection rocuronium at 0.6 mg/kg, 0.9 mg/kg respectively and Group C received succinylcholine at 2 mg/kg. Onset of action of relaxant, intubation conditions, time taken to intubate and duration of action were compared. Statistical Analysis Used: To compare the statistical difference in the age, weight, height of the study subjects, onset of action of relaxant, intubation conditions, time taken to intubate, and duration of action analysis of variance and unpaired t-test were used. Results: The onset time was considerably shorter with rocuronium 0.9 mg/kg than 0.6 mg/kg. The onset time of rocuronium 0.9 mg/kg was found to be significantly longer than succinylcholine 2 mg/kg. Time taken to intubate was shortest with succinylcholine 2 mg/kg. The time taken to intubate with the rocuronium 0.9 mg/kg was found to be comparable to that of rocuronium 0.6 mg/kg. Intubation score of rocuronium 0.9 mg/kg was the best (17.75), which was comparable with succinylcholine. However, the intubation score obtained with rocuronium 0.6 mg/kg was inferior. Duration of action was shortest with succinylcholine. The duration of action is prolonged when the dose of rocuronium is increased from 0.6 to 0.9 mg/kg. Conclusion: Rapid sequence induction of anesthesia with propofol and fentanyl, succinylcholine allowed a more rapid endotracheal intubation sequence and created superior intubation conditions than rocuronium. However, the technique of using a large dose of rocuronium to achieve perfect conditions for tracheal intubation may have application whenever succinylcholine is relatively contraindicated. [ABSTRACT FROM AUTHOR]

The present study was designed to compare the intubating conditions of rocuronium giving by "a modified timing principle" in rapid induction and intubation (RSII) with that of the gold standard, succinylcholine. One hundred and twenty-four patients were randomly divided into rocuronium group (group R, n = 62) or succinylcholine group (group S, n = 62). In group R, after rocuronium 0.6 mg kg−1 was given, anaesthesia was induced with propofol 2 mg kg−1 and remifentanil 2 μg kg−1, and tracheal intubation was performed 60 sec after rocuronium administration. In group S, succinylcholine 1.5 mg kg−1 was given after patient lost consciousness induced by the same regimen of group R, and tracheal intubation was performed 60 sec after succinylcholine administration. Our primary endpoint was the intubating conditions. The numbers of patients with excellent and good intubating conditions in group R were 90.0% and 6.7%, respectively, which were comparable with those in group S (91.7% and 5.0% respectively). The apnoea time in group S (79.7 ± 5.1 sec) was longer than that of group R (56.6 ± 4.6 sec) (p = 0.0063). The average BIS values at the time of intubation in group R (64.1 ± 4.1) was higher than that of group S (43.2 ± 5.5) (p = 0.018). In the context of a RSII with lidocaine–remifentanil–propofol, the application of this "modified timing principle" with rocuronium 0.6 mg kg−1 could provide comparable intubating conditions with those achieved by succinylcholine 1.5 mg kg−1. Additionally, this modified timing principle with rocuronium was associated with shorter apnoea time. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare FAIS rates for rocuronium and succinylcholine when used for RSI in the emergency department (ED). B Introduction: b Succinylcholine and rocuronium are commonly used paralytics for rapid sequence intubation (RSI). No difference was observed in FAIS between patients receiving rocuronium (median dose: 1.22 mg/kg, IQR 1.04-1.55) or succinylcholine (median dose: 1.43 mg/kg, IQR 1.25-1.67) (361 (80.6%) vs. 150 (82.0%), p=0.69). [Extracted from the article]