Rapid tracheal intubation with atracurium - a comparison of priming intervals

determine the optimal interval between the administration of the priming dose and the intubating dose, atracurium was given to 44 patients either in a single dose of 0.5 mg.kg^-1 or in an initial dose of0.06mg.kg^-1 followed two, three or five minutes later with 0.44 mg.kg^-1. When atracurium was given as a single bolus of 0.5 mg. kg^-1 the time to 100 per cent twitch suppression (onset time) was90.9 ± 36 (mean ± SD) seconds. When the priming interval was two minutes, the onset time of the intubating dose was 76.6 ± 42.2 seconds (p = NS). But when the priming interval was three or five minutes, the onset timeswere42.2 ± 16.5(p<0.01)and52.6 ± 28.8(p < 0.05) seconds respectively. Waiting for five minutes after the administration of the priming dose did not improve the intubating conditions. It is concluded that three minutes appears to be the optimal time interval for the administration of atracurium in divided doses. When a priming dose of atracurium is given three minutes before the intubating dose, it can provide an alternative to succinylcholine for rapid endotracheal intubation.