British Journal of Anaesthesia, Vol 82, Issue 4 537-541, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
H. J. Sparr, H. Mellinghoff, M. Blobner and G. Noldge-Schomburg
We have assessed intubating conditions provided by rapacuronium (Org 9487)
and succinylcholine after rapid sequence induction of anaesthesia in adult
patients undergoing elective surgery. We studied 335 patients, ASA I and
II, in five centres. Two hundred and thirty-four subjects with normal body
weight and 101 obese subjects were allocated randomly to one of four
treatment groups differing in the neuromuscular blocking drug administered
(rapacuronium 1.5 mg kg-1 or succinylcholine 1 mg kg- 1) and in the
technique used for induction of anaesthesia (fentanyl 2-3 micrograms kg-1
with thiopental 3-6 mg kg-1 or alfentanil 20 micrograms kg-1 with propofol
1.5-2 mg kg-1). Intubation was started at 50 s by an anaesthetist blinded
to the drugs used. Intubating conditions were clinically acceptable
(excellent or good) in 89.4% of patients after rapacuronium and in 97.4%
after succinylcholine (P = 0.004), the estimated difference being 8.1% (95%
confidence interval (CI) 2.0- 14.1%). Neither anaesthetic technique nor
subject group had an influence on intubating conditions. After intubation,
the maximum increase in heart rate averaged 23.1 (SD 25.4%) and 9.4 (26.1%)
after rapacuronium and succinylcholine, respectively (P < 0.001).
Pulmonary side effects (bronchospasm and increased airway pressure) were
observed in 10.7% (95% CI 5.8-17%) and 4.1% (95% CI 1.3-8.8%) of patients
given rapacuronium and succinylcholine, respectively (P = 0.021). We
conclude that after rapid sequence induction of anaesthesia in adults,
clinically acceptable intubating conditions were achieved less frequently
after rapacuronium 1.5 mg kg-1 than after succinylcholine.
CLINICAL INVESTIGATIONS
Comparison of intubating conditions after rapacuronium (Org 9487) and succinylcholine following rapid sequence induction in adult patients
Department of Anaesthesia and Intensive Care Medicine, The Leopold-Franzens- University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria; Department of Anaesthesiology and Surgical Intensive Care Medicine, University of Cologne, Germany; Department of Anaesthesiology, The Technische Universitat Munchen, Munich, Germany; Department of Anaesthesia, Albert-Ludwig-University of Freiburg, Germany
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