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Skinner HJ. Biswas A. Mahajan RP., Evaluation of intubating conditions with rocuronium and either propofol or etomidate for rapid sequence induction. Anaesthesia. Anaesthesia. 53(7):702-6, 1998.
The authors assessed the effect of two induction agents on tracheal intubating conditions after rocuronium 0.6 mg/kg in unpremedicated patients undergoing simulated rapid sequence induction. Following pre-oxygenation, anesthesia was induced with propofol up to 2.5 mg/kg (n = 35) or etomidate 0.3 mg/kg (n = 36), and further increments as required. After loss of verbal contact, cricoid pressure was applied and rocuronium was injected. Laryngoscopy was performed at 45 s and intubation attempted at 60 s after rocuronium had been given. Ninety-four per cent of patients in the propofol group had clinically acceptable (good or excellent) intubating conditions compared to only 75% in the etomidate group (p = 0.025). Owing to coughing, one patient in the etomidate group could not be intubated on the first attempt. A greater pressor response also followed intubation after induction with etomidate. The authors conclude that etomidate and rocuronium alone cannot be recommended for intubation at 60 s under rapid sequence induction conditions.
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