Vijay Anand, G (2006) A Comparative Evaluation of Rocuronium and Suxamethonium following Rapid Sequence Intubation in Emergency Surgeries. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Endotracheal intubation is an integral part of administration of anaesthesia during surgical procedures. Suxamethonium, a depolarizing muscle relaxant with its rapid onset and short duration of action is still the relaxant of choice to facilitate tracheal intubation. In addition to fasciculations, Suxamethonium has got many side effects such as bradycardia and other dysrhythmias, rise in serum potassium, post-operative myalgia, rise in intraocular, intragastric and intracranial pressure, prolonged recovery in patients with pseudo-cholinesterase deficiency and triggering of malignant hyperthermia. Because most of the side effects of Suxamethonium reflect its depolarizing mechanism of action, search for ideal neuromuscular blocking agent focused on non-depolarizing type of relaxants which has rapid onset time and offers good to excellent intubating conditions, as rapidly as Suxamethonium and which lacks the above mentioned adverse effects. AIMS OF THE STUDY: 1. To compare the intubating conditions of Rocuronium with Suxamethonium at 60 seconds, in emergency surgeries following rapid sequence intubation. 2. To compare the hemodynamic response to intubation. MATERIALS AND METHODS: Study design: This study was a randomized prospective comparative study. Study setting and population: After obtaining institutional ethical committee clearance, the study was carried out on 40 patients in the emergency OT, Department of Anesthesiology, Madras Medical College, Chennai, from January to June 2005. The patients were randomly selected from either sex, between 18 to 60 years of age, and weighing between 50-70 kgs. Emergency cases posted under G.A. and assessed between ASA status I – III, without significant disturbance in hemodynamic status or metabolic/electrolyte/ acid-base disturbance were chosen. These cases included 1. neurosurgical emergencies for craniotomy & evacuation such as extra-dural / sub-dural haematoma and depressed fracture of the skull. 2. blunt injury abdomen for laparotomy. 3. hollow viscus perforation. 4. acute appendicitis for appendicectomy. 5. vascular/tendon injuries of the upper limb. 6. compound fracture both bones of the fore-arm for external fixator application. INCLUSION CRITERIA: • Adults between 18 – 60 years. • ASA Physical status I , II & III. • Emergency surgeries posted under G.A. • Closed head injuries with GCS > 13. EXCLUSION CRITERIA: • Children, • Pregnancy, • Obesity, • Known / suspected difficult Intubation, • H/o any neuromuscular disorder, • Renal / Hepatic disorder, • Head injuries with GCS < 13, • Hypovolemia/ Shock, • Severe metabolic/electrolyte/ acid-base disturbances, • Known allergy to drugs, • Surgical procedures of very short duration, • Patients receiving any medication known to interact with Neuromuscular blocking agent. SUMMARY: Rocuronium 0.6mg/kg (2 x ED 95) produced acceptable intubating conditions (good or excellent) in 1 minute. • Excellent intubating conditions were observed in Suxamethonium group at 1 minute. • Rocuronium, at the dose of 0.6 mg/kg (2 x ED95) did not show any adverse hemodynamic response, and the hemodynamic profile was comparable to Suxamethonium. CONCLUSION: Both Rocuronium and Suxamethonium produced good to excellent intubating conditions for rapid sequence intubation. Rocuronium in the dose of 0.6 mg/kg, had a comparable hemodynamic profile to Suxamethonium, and can be used as the next best alternative to Suxamethonium as a part of rapid sequence induction provided there is no anticipated difficulty in intubation. Rocuronium appears to be safe with less adverse effects and effective for rapid sequence intubation of selected patients in whom contraindications to Succinylcholine exist.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Rocuronium ; Suxamethonium ; Rapid Sequence Intubation ; Emergency Surgeries. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Apr 2018 17:34 |
| Last Modified: | 16 Apr 2018 17:34 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7032 |
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