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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

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


Introduction. The aim of the study was to determine intubation conditions in the patients receiving rocuronium in comparison to succinylcholine for rapid sequence intubation during the induction of anesthesia for operative management of bowel obstruction.

Methods. In the randomized controlled study 30 adult patients with bowel obstruction undergoing urgent surgery were randomly 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 grading system according to Viby-Morgenson. Primary outcomes were intubation conditions 1 minute after the application of a muscle relaxant. Secondary outcome measures were heart rate, blood pressure, and pulse oximetry; potassium and myoglobin serum level.

Results. All patients were orotracheally intubated in the first attempt. During induction, we didn’t observe vomiting or aspiration. 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 obstruction enables the same intubation conditions as succinylcholine and the same risk of aspiration which allows succinylcholine replacement and avoidance of its side effects.

Key words: Rocuronium, succinylcholine, rapid sequence intubation, bowel obstruction, intubation conditions

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Emerging considerations in the reversal of neuromuscular blockade and residual block


Incomplete recovery following reversal of neuromuscular blockade can present as a clinical problem in surgical patients. Emerging pharmacologic solutions may prevent such adverse outcomes in the future. We briefly review two methods of pharmacologic reversal of neuromuscular blockade. Both methods of reversal are effective. However the early studies of the new compound, sugammadex has been shown to achieve a more rapid, stable reversal of steroidal based neuromuscular blocking agents compared to neostigmine. Due to the novel mechanism of action of this agent, sugammadex has been demonstrated to be effective even when administered during profound neuromuscular block, without evidence of recurarization.

Key words: sugammadex, Org 25969, cyclodextrin, rocuronium, cholinesterase inhibitor

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