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Rapacuronium 2.0 or 2.5 mg kg-1 for rapid-sequence induction: Comparison with succinylcholine 1.0 mg kg-1

Lookup NU author(s): Dr Peter Wright

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Abstract

The purpose of this nine-centre study in 602 patients was to show that the frequency of acceptable intubating conditions after rapacuronium 2.0 or 2.5 mg kg-1 is not more than 10% lower than the frequency after succinylcholine 1.0 mg kg-1 during rapid-sequence induction of anaesthesia with fentanyl 1-2 μg kg-1 and thiopental 2-7 mg kg-1. Laryngoscopy and intubation were carried out 60 s after administration of muscle relaxant by an anaesthetist blinded to its identity. Intubating conditions were clinically acceptable (excellent or good) in 91.8% of patients given succinylcholine and in 84.1 and 87.6% of patients given rapacuronium 2.0 and 2.5 mg kg-1 respectively. With respect to the percentage of clinically acceptable intubating conditions, the estimated difference (and the upper limit of the one-sided 97.5% confidence interval) between succinylcholine and rapacuronium 2.0 mg kg-1 was 7.8 (14.4)% and between succinylcholine and rapacuronium 2.5 mg kg-1 it was 4.0 (10.2)%. For both comparisons, the upper limit of the one-sided confidence interval exceeded the predefined 10% difference. Hence, it could not be demonstrated that the intubating conditions with either of the two doses of rapacuronium were not inferior to those with succinylcholine 1.0 mg kg-1. The increase in heart rate was significantly greater during the first 5 min in the rapacuronium groups, but the arterial pressure increased significantly only in the succinylcholine group (P<0.001). Respiratory side-effects were observed in 4.0, 13.5 and 18.5% of patients after succinylcholine and rapacuronium 2.0 and 2.5 mg kg-1 respectively (P<0.05). As the non-inferiority of intubating conditions after rapacuronium 2.0 and 2.5 mg kg-1 could not be proven, succinylcholine should be considered the neuromuscular blocking agent that provides better intubating conditions for rapid-sequence induction.

Publication metadata

Author(s): Blobner M, Mirakhur RK, Wierda JMKH, Wright PMC, Olkkola KT, Debaene B, Pendeville P, Engbaek J, Rietbergen H, Sparr HJ

Publication type: Article

Publication status: Published

Journal: British Journal of Anaesthesia

Year: 2000

Volume: 85

Issue: 5

Pages: 724-731

Print publication date: 01/01/2000

ISSN (print): 0007-0912

ISSN (electronic): 1471-6771

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1093/bja/85.5.724

DOI: 10.1093/bja/85.5.724

PubMed id: 11094588

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