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Table of Contents
LETTER TO THE EDITOR
Year : 2011  |  Volume : 27  |  Issue : 3  |  Page : 416

Can the use of sevoflurane with rocuronium reconcile the debate on succinylcholine versus rocuronium for rapid sequence intubation?


Department of Cardiac Anesthesia, C.N.C. All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication11-Aug-2011

Correspondence Address:
Usha Kiran
Room #6. 7th Floor, C.N.C. A.I.I.M.S. New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.83701

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How to cite this article:
Sujatha M, Sukesan S, Kiran U. Can the use of sevoflurane with rocuronium reconcile the debate on succinylcholine versus rocuronium for rapid sequence intubation?. J Anaesthesiol Clin Pharmacol 2011;27:416

How to cite this URL:
Sujatha M, Sukesan S, Kiran U. Can the use of sevoflurane with rocuronium reconcile the debate on succinylcholine versus rocuronium for rapid sequence intubation?. J Anaesthesiol Clin Pharmacol [serial online] 2011 [cited 2019 Oct 20];27:416. Available from: http://www.joacp.org/text.asp?2011/27/3/416/83701

Sir,

With interest we read the article by Kulkarni et al., [1] and appreciate their efforts to validate rocuronium 0.9 mg as better alternative to succinylcholine for moderate duration surgeries in pediatric patients. We would like to share with the readers our center's experience in pediatric patients with congenital heart diseases (cyanotic and acyanotic) undergoing cardiac surgeries.

Rocuronium can be considered a suitable alternative to succinylcholine for rapid-sequence induction in most clinical situations except in clinical situations demanding absolute optimization of intubating conditions or when the longer duration of action of rocuronium is contraindicated. Magorian et al.[2] compared three different doses (0.6, 0.9 and 1.2 mg/ kg) of rocuronium with 1 mg/kg succinylcholine and found that the onset times of rocuronium in doses of 0.9 and 1.2 mg/kg were similar to that of succinylcholine. They concluded that rocuronium 0.6-1.2 mg/kg is the appropriate dose for rapid sequence induction. The only disadvantage of high dose (1.2 mg/kg) was the longer duration of action, which was not desirable in short procedures. Considerable debate continues over the dosing of rocuronium in rapid sequence intubation in comparison to succinylcholine, with some studies stating the dose of rocuronium needed to be at least 1.0 mg/kg or even as high as 2.0 mg/kg. [2],[3]

Surgeries at out center have a minimum duration of 1-1½ h and thus duration of neuromuscular blockade is not an issue. We follow the intubation doses used by Sparr et al. i.e. 1.5 mg rocuronium. In contrast to most debated studies which used propofol, we use sevoflurane 3-5% in a 50 : 50 air : oxygen mixture for inhalational induction of anesthesia. An intravenous access line is secured, fentanyl 3 mcg/kg and rocuronium 1.5 mg/kg intravenous are administered and sevoflurane is tapered off. Excellent intubating conditions are achieved at 30 s, with no episodes of hemodynamic or respiratory sequelae in a high risk patient population, while keeping at bay the unwanted effects of succinylcholine. These conditions can be attributed to both the initial use of sevoflurane and the quick onset of rocuronium. Further studies are required to determine whether rocuronium can be exclusively credited for these effects, as this condition is also not achieved with the sole use of sevoflurane either.

 
   References Top

1.Kulkarni KR, Patil MR, Shirke AM. Comparison Of Intubating Conditions Of Succinylcholine With Two Doses Of Rocuronium Bromide In Children. J Anaesth Clin Pharmacol 2010;26:323-8.  Back to cited text no. 1
  Medknow Journal  
2.Magorian T, Flannery KB, Miller RD. Comparison Of Rocuronium, Succinylcholine, And Vecuronium For Rapid-Sequence Induction Of Anesthesia In Adult Patients. Anesthesiology 1993;79:913-6.  Back to cited text no. 2
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3.Caldwel JE. Rapid Sequence Intubation: Is Rocuronium An Alternative? Seminars In Anesthesia. Perioper Med Pain 2002;21:99-103.  Back to cited text no. 3
    




 

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