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Original Research

Open Access

Rocuronium versus succinylcholine for rapid sequence intubation in patients with bowel obstruction

  • LIDIJA PERŠA1
  • MIRT KAMENIK1,2
  • NEVENKA1,2
  • KRČEVSKI ŠKVARČ1,2
  • DUŠAN MEKIŠ1,2

1Department of Anesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Ljubljanska 5, Maribor, Slovenia

2Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia

DOI: 10.22514/SV152.102019.8 Vol.15,Issue 2,September 2019 pp.52-58

Published: 20 September 2019

*Corresponding Author(s): DUŠAN MEKIŠ E-mail: dusan.mekis@ukc-mb.si

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Abstract

Introduction. The aim of the study was to determine intubation conditions in the patients receiving rocuronium in compari-son to succinylcholine for rapid sequence intubation during the induction of anes-thesia for operative management of bowel obstruction. 

Methods. In the randomized controlled study 30 adult patients with bowel obstruc-tion undergoing urgent surgery were ran-domly allocated in two groups. For muscle relaxation the S-group of patients received succinylcholine (1.5 mg/kg) and the R-group rocuronium (1.2 mg/kg). Intubation conditions were evaluated using a grad-ing system according to Viby-Morgenson. Primary outcomes were intubation con-ditions 1 minute after the application of a muscle relaxant. Secondary outcome measures were heart rate, blood pressure, and pulse oximetry; potassium and myo-globin serum level.

Results. All patients were orotracheally intubated in the first attempt. During in-duction, we didn’t observe vomiting or as-piration. Overall intubation conditions in the S-group were statistically significantly better than in the R-group. After RSI there was a statistically significant decrease in systolic and diastolic blood pressure in both groups and statistically significant decrease in heart rate in the S-group. After RSI the potassium level in the S-group was significantly higher in comparison to the R-group and serum myoglobin level non-significantly increased in the S-group and statistically significantly decreased in the R-group.

Conclusion. The results show that rocuronium in RSI patients with bowel obstruc-tion enables the same intubation condi-tions as succinylcholine and the same risk of aspiration which allows succinylcholine replacement and avoidance of its side ef-fects.

Keywords

Rocuronium, succinylcholine, rapid sequence intubation, bowel obstruc-tion, intubation conditions

Cite and Share

LIDIJA PERŠA,MIRT KAMENIK,NEVENKA,KRČEVSKI ŠKVARČ,DUŠAN MEKIŠ. Rocuronium versus succinylcholine for rapid sequence intubation in patients with bowel obstruction. Signa Vitae. 2019. 15(2);52-58.

URL:

https://www.signavitae.com/articles/10.22514/SV152.102019.8

References

1. S Griffiths, DG Glancy. Intestinal obstruction. Surgery - Oxford International Edition, 2014: 32 , 204-211.

2. Mencke T, Zitzmann A, Reuter DA. Certan and controversial components in rapid sequence induction.Anaesthesist 2018; Epub ahead of print.

3. Sparr HJ, Jöhr M. Succinylcholin – Update. Anaesthesist 2002; 51: 565-575.

4. Di Filippo A, Gonnelli C. Rapid sequence intubation: a review of recent evidences. Rev Recent Clin Trials 2009; 4: 175-178.

5. Marvez-Valls E, Houry D, Ernst AA, Weiss SJ, Killen J. Protocol for rapid sequence intubation in pediatric patients – a four year study. Med Sci Monit 2002; 8: 229-234.

6. Wallace C, McGuire B. Rapid sequence induction: its place in modern anaesthesia. Cont Edu Anaesth Crit Care and Pain 2014; 14:

130- 135.

7. Salem MR, Clark-Wronski J, Khorasani A, Crystal GJ. Which is the original and which is the modified rapid sequence induction and intubation? Let history be judge! Anesth Analg 2013; 116: 264-265.

8. Ehrenfeld JM, Cassedy EA, Forbes VE, Mercaldo ND, Sandberg WS. Modified rapid sequence induction and intubation: a survey of United States current practice. Anesth Analg 2012; 115: 95-101.

9. Lee C. Goodbye Suxamethonium!.Anaesthesia 2009; 64: 73-81.

10. Craig RG, Hunter JM. Neuromuscular blocking drugs and their antagonists in patients with organ disease. Anaesthesia 2009; 64:

55- 65.

11. Zoremba N, Schälte G, Bruells C, Pühringer FK. Update on muscle relaxation: What comes after succinylcholine, rocuronium and sugammadex?. Anaesthesist 2017; 66: 353-359.

12. Naquin M, Gambol MA. Adverse effects of neuromuscular blockers and their antagonists. Drug Safety 1998; 18:99-116.

13. Claudius C, Garvey LH, Viby-Morgenson J. The undesirable effects of neuromuscular blocking drugs. Anaesthesia 2009; 64: 10-21.

14. Booij LHDJ. The use of rocuronium in various clinical situations. ASEAN Journal of Anaesthesiology 2005; 6:

15. Schaller SJ, Fink H. Sugammadex as a reversal agent for neuromuscular block: an evidence – based review. Core Evid 2013; 8: 57-67.

16. Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesth Analog 2007;104: 575-581.

17. Chingmuh L, Jahr JS, Candiotti KA, Warriner B, Zornow MH, Naguib M. Reversal of profound neuromuscular block by sugamma-dex administered three minutes after rocuronium. Anaesthesiology 2009; 110; 1020-1025.

18. De Boer HD, Driessen JJ, Marcus MAE, Kerkamp H, Heering M, Klimek M. Reversal of rocuronium induced (1.2 mg/kg) profound neuromuscular block by sugammadex. Anesthesiology 2007; 107: 239-244.

19. Mencke T, Knoll H, Schreiber JU, Echternach M, Klein S, Noeldge-Schomburg G et al. Rocuronium is not associated with more vocal cord injuries than succinylcholine after rapid sequence induction: a randomized, prospective, controlled trial. Anesth Analg 2006; 102: 943-949.

20. https://www.isrctn.com/ISRCTN11777647).

21. http://193.2.12.193/generator/generator.html)

22. Viby-Mogensen J, Engbaek J, Eriksson LI, Gramstad L, Jensen E, Jensen FS et al. Good clinical research practice (GCRP) in pharma-codynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40: 59-74.

23. Naguib M, Samarkandi AH, El-Din ME, Abdullah K, Khaled M, Alharby SW. The dose of succinylcholine required for excellent endotracheal intubating conditions. Anesth Analg 2006; 102: 151-5.

24. McCourt KC, Salmela l, Mirakhur RK, Carroll M, Mäkinen MT, Kansanaho M et al. Comparison of rocuronium and suxametho-nium for use during rapid sequence induction of anaesthesia. Anaesthesia 1998; 53: 867-871.

25. Luxen J, Trentzsch H, Urban B. Rocuronium and sugammadex in emergency medicine: requirements of a muscle relaxant for rapid sequence intubation. Anaesthesist 2014; 63: 331-337.

26. Perry J, Lee J, Wells G. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2003; 1:CD002788.

27. Tran DTT, Newton EK, Mount VAH, Lee JS, Mansour C, Wells GA et al. Rocuronium vs. succinylcholine for rapid sequence intuba-tion: a Cohrane systematic review. Anaesthesia 2017; 72: 765-777.

28. Girard T. Pro: rocuronium should replace succinylcholine for rapid sequence induction. Eur J Anaesthesiol 2013; 30: 585-589.

29. Sorenson MK, Bretlau C, Gätke MR, Sorenson AM, Rasmussen LS. Rapid sequence induction and intubation with rocuronium –sugammadex compared with succinylcholine: a randomized trial. Br J of Anaesth 2012; 108: 682-689.

30. Laurin EG1, Sakles JC, Panacek EA, Rantapaa AA, Redd J. A comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients. Acad Emerg Med 2000; 7:1362-9.

31. Patanwala AE, Stahle SA, Sakles JC, Erstad BL. Comparison of succinylcholine and rocuronium for first-attempt intubation success in the emergency department. Acad Emerg Med 2011; 18: 10-14.

32. Sabo D, Jahr J, Pavlin J, Pholip B, Shimode N, Rowe E et al.The increase in potassium concentrations are greater with succinylcholine than with rocuronium – sugammadex in outpatient surgery: a randomized multicenter trial. Can J Anaesth 2014; 61: 423-432.

33. Martyn JA1, Richtsfeld M. Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms.Anesthesiology.2006; 104:158-69.

34. Frederiksen B, Steensen M, Carl P. Fatal succinylcholine induced hyperkalemia in an intensive care unit. Ugeskr Laeger 2011; 173: 2704-2705

35. Hernandez-Palazon J, Noguera-Velasco J, Falcon-Arana LF, Domenech-Asensi P, Burguillos-Lopez S, Nuno de la Rosa-Carrilo V. Precurarization with rocuronium prevents fasciculations and biochemical changes after succinylcholine administration. Rev Esp Anestesiol Reanim 2004; 51: 184-189.

36. Farhat K, Pasha AK, Jaffery N. Biochemical changes following succinylcholine administration after pretreatment with rocuronium at different intervals. J Pak Med Assoc. 2014; 64: 146-150.

37. Ozlu O, Eris S, Mert A. Effects of rocuronium pretreatment on muscle enzyme levels following suxamethonium. Paediatr Anaesth 2002; 12: 151-155.

38. Harper NJN, Cook TM, Garcez T, Farmer L, Floss K, Marinho S et al. Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Br J Anaesth 2018; 121:159-171.

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