Rapacuronium 2.0 or 2.5 mg kg-1 for rapid-sequence induction: comparison with succinylcholine 1.0 mg kg-1 |
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| Authors: | Blobner M Mirakhur R K Wierda J M Wright P M Olkkola K T Debaene B Pendeville P Engbaek J Rietbergen H Sparr H J |
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| Affiliation: | Departments of Anaesthesia, 1Technische Universität München, Klinikum r. d. Isar, Munich, Germany. 2The Queen’s University of Belfast, Belfast, UK. 3University Hospital of Groningen, Groningen, The Netherlands. 4University of Newcastle upon Tyne, Newcastle upon Tyne, UK. 5Helsinki University Central Hospital, Helsinki, Finland. 6Institut Gustave Roussy, Paris, France. 7Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 8Herlev University Hospital København, Copenhagen, Denmark. 9Organon Teknika BV, Boxtel, The Netherlands. 10Leopold-Franzens Universität Innsbruck, Innsbruck, Austria |
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| Abstract: | The purpose of this nine-centre study in 602 patients was toshow that the frequency of acceptable intubating conditionsafter rapacuronium 2.0 or 2.5 mg kg1 is notmore than 10% lower than the frequency after succinylcholine1.0 mg kg1 during rapid-sequence inductionof anaesthesia with fentanyl 12 µg kg1and thiopental 27 mg kg1. Laryngoscopyand intubation were carried out 60 s after administrationof muscle relaxant by an anaesthetist blinded to its identity.Intubating conditions were clinically acceptable (excellentor good) in 91.8% of patients given succinylcholine and in 84.1and 87.6% of patients given rapacuronium 2.0 and 2.5 mg kg1respectively. With respect to the percentage of clinically acceptableintubating conditions, the estimated difference (and the upperlimit of the one-sided 97.5% confidence interval) between succinylcholineand rapacuronium 2.0 mg kg1 was 7.8 (14.4)%and between succinylcholine and rapacuronium 2.5 mg kg1it was 4.0 (10.2)%. For both comparisons, the upper limit ofthe one-sided confidence interval exceeded the predefined 10%difference. Hence, it could not be demonstrated that the intubatingconditions with either of the two doses of rapacuronium werenot inferior to those with succinylcholine 1.0 mg kg1.The increase in heart rate was significantly greater duringthe first 5 min in the rapacuronium groups, but the arterialpressure increased significantly only in the succinylcholinegroup (P<0.001). Respiratory side-effects were observed in4.0, 13.5 and 18.5% of patients after succinylcholine and rapacuronium2.0 and 2.5 mg kg1 respectively (P<0.05).As the non-inferiority of intubating conditions after rapacuronium2.0 and 2.5 mg kg1 could not be proven, succinylcholineshould be considered the neuromuscular blocking agent that providesbetter intubating conditions for rapid-sequence induction. Br J Anaesth 2000; 85: 72431 * Corresponding author: Klinik für Anaesthesiologie der TechnischenUniversität München, Klinikum rechts der Isar, IsmaningerStr. 22, D-81675 München, Germany |
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