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Andrews JI. Kumar N. van den Brom RH. Olkkola KT. Roest GJ. Wright PM., A large simple randomized trial of rocuronium versus succinylcholine in rapid-sequence induction of anaesthesia along with propofol. Acta Anaesthesiologica Scandinavica. 43(1):4-8, 1999.
Because rocuronium has an onset of action more rapid than other non-depolarizing neuromuscular blocking agents, it is unclear whether it and succinylcholine give equivalent intubating conditions during rapid-sequence induction of anesthesia. The authors therefore performed this study to answer the question--are there clinically relevant differences between the use of rocuronium and succinylcholine to secure acceptable intubating conditions during rapid-sequence induction of anesthesia with propofol. Anesthesia was induced using propofol 2.5 mg/kg in 349 ASA physical status grade I-IV patients who were undergoing either elective or emergency surgery. Propofol was followed immediately by either rocuronium 0.6 or 1 mg/kg or succinylcholine 1.0 mg/kg (randomly selected). Fifty seconds after the end of muscle relaxant injection laryngoscopy was performed and intubating conditions were graded by an experienced anesthetist blind to the muscle relaxant allocation. This study design was selected so that a 10% difference in clinically acceptable intubating conditions between drugs would be detectable. In this setting rocuronium 1.0 mg/kg provided superior intubating conditions compared with rocuronium 0.6 mg/kg. The incidence of clinically acceptable intubating conditions with rocuronium 1.0 mg/kg and succinylcholine 1.0 mg/kg was 93.2% and 97.1% respectively, the difference being -3.9% (95% C.I. -9.7% to 1.9%). The authors conclude that rocuronium 1.0 mg/kg given along with propofol in a rapid-sequence induction of an is clinically equivalent to succinylcholine 1.0 mg/kg.
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