Rocuronium Versus Succinylcholine for Rapid Sequence Induction of Anesthesia and Endotracheal Intubation

Nawfal Khazaal Hadid

Authors

Nawfal Khazaal Hadid Salahaddin Health Directorate, Salahaddin Governorate, Iraq

Keywords:

Rocuronium, Succinylcholine, Rapid Sequence Induction, Endotracheal Intubation, Neuromuscular Blocking Agents

Abstract

Succinylcholine has been used in the past for rapid sequence induction (RSI) due to its short acting and fast onset. It can, however, produce clinically significant undesirable effects such as hyperkalemia, bradycardia, myalgia, and long-lasting paralysis in patients with atypical pseudocholinesterase. Rocuronium is a non-depolarizing agent with a short latency and long duration of action. Rocuronium bromide is used for rapid sequence intubation (RSI) due to its rapid action and short duration of effect. Currently, rocuronium bromide is used for RSI because of its short onset and duration of action. This was a randomized comparative study of 60 adults (ASA physical status I-II and Mallampati grade I-II) during the period of 1 March 2023 to 30 January 2024 at Baghdad teaching hospital and Rizgari teaching hospital. The 30 first participants (Group A) were treated with rocuronium 0.6 mg/kg and the next 30 (Group B) with succinylcholine 1.5 mg/kg. The intubating conditions were scored according to the Cooper scoring system at around 60 seconds with a maximum of 75 or 90 seconds for assessment if necessary. The patients receiving rocuronium (n=27) had excellent intubating conditions in 90%, and good conditions in the remaining 3 patients; patients receiving succinylcholine (n=30) had 100% excellent intubating conditions. There were no reports of poor or inadequate conditions. First-attempt intubation was successful in 28/30 patients (93%) in the rocuronium group and 29/30 (97%) of the succinylcholine group. Overall, clinically acceptable conditions (p>0.05) were not statistically different between the two groups of study. The two agents in this limited study were found to give clinically acceptable intubating conditions. A higher percentage of excellent conditions was obtained with succinylcholine, which also may be used when succinylcholine is contraindicated. There are limitations in conclusions drawn for uncommon complications due to the small sample size and lack of blinding.

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