Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial

TY - JOUR

T1 - Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine

T2 - a randomized trial

AU - Sørensen, M K

AU - Bretlau, C

AU - Gätke, M R

AU - Sørensen, A M

AU - Rasmussen, L S

PY - 2012/4

Y1 - 2012/4

N2 - Background: An unanticipated difficult airway may arise during rapid sequence induction and intubation (RSII). The aim of the trial was to assess how rapidly spontaneous ventilation could be re-established after RSII. We hypothesized that the time period from tracheal intubation to spontaneous ventilation would be shorter with rocuroniumsugammadex than with succinylcholine. Methods: This randomized and patient- and observer-blinded trial was approved by the regional Ethics Committee and the Danish Medicines Agency. We included elective surgical patients undergoing general anaesthesia for RSII using alfentanil (10 μg kg-1), propofol (2 mg kg -1), and either succinylcholine (1 mg kg-1) or rocuronium (1 mg kg-1). Sugammadex (16 mg kg-1) was given in the rocuronium group after tracheal intubation. The primary endpoint was the time from correct placement of the tracheal tube to spontaneous ventilation, defined as a respiratory rate of more than 8 bpm and a tidal volume of at least 3 ml kg-1 for 30 s. Results: We included 61 patients; of whom, 55 were evaluated for the primary endpoint. The median time from tracheal intubation to spontaneous ventilation was 406 s with succinylcholine and 216 s with rocuroniumsugammadex (P=0.002). The median time from tracheal intubation to 90% recovery of the first twitch in train-of-four (T1 90%) was 518 s with succinylcholine and 168 s with rocuroniumsugammadex (P < 0.0001). Intubation conditions and time to tracheal intubation were not significantly different. Conclusions: RSII with rocuronium followed by reversal with sugammadex allowed earlier re-establishment of spontaneous ventilation than with succinylcholine.

AB - Background: An unanticipated difficult airway may arise during rapid sequence induction and intubation (RSII). The aim of the trial was to assess how rapidly spontaneous ventilation could be re-established after RSII. We hypothesized that the time period from tracheal intubation to spontaneous ventilation would be shorter with rocuroniumsugammadex than with succinylcholine. Methods: This randomized and patient- and observer-blinded trial was approved by the regional Ethics Committee and the Danish Medicines Agency. We included elective surgical patients undergoing general anaesthesia for RSII using alfentanil (10 μg kg-1), propofol (2 mg kg -1), and either succinylcholine (1 mg kg-1) or rocuronium (1 mg kg-1). Sugammadex (16 mg kg-1) was given in the rocuronium group after tracheal intubation. The primary endpoint was the time from correct placement of the tracheal tube to spontaneous ventilation, defined as a respiratory rate of more than 8 bpm and a tidal volume of at least 3 ml kg-1 for 30 s. Results: We included 61 patients; of whom, 55 were evaluated for the primary endpoint. The median time from tracheal intubation to spontaneous ventilation was 406 s with succinylcholine and 216 s with rocuroniumsugammadex (P=0.002). The median time from tracheal intubation to 90% recovery of the first twitch in train-of-four (T1 90%) was 518 s with succinylcholine and 168 s with rocuroniumsugammadex (P < 0.0001). Intubation conditions and time to tracheal intubation were not significantly different. Conclusions: RSII with rocuronium followed by reversal with sugammadex allowed earlier re-establishment of spontaneous ventilation than with succinylcholine.

U2 - 10.1093/bja/aer503

DO - 10.1093/bja/aer503

M3 - Journal article

C2 - 22315329

SN - 0007-0912

VL - 108

SP - 682

EP - 689

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 4

ER -