British Journal of Anaesthesia, 2000, Vol. 85, No. 5 724-731
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia
Rapacuronium 2.0 or 2.5 mg kg–1 for rapid-sequence induction: comparison with succinylcholine 1.0 mg kg–1
Departments of Anaesthesia, 1Technische Universität München, Klinikum r. d. Isar, Munich, Germany. 2The Queen’s University of Belfast, Belfast, UK. 3University Hospital of Groningen, Groningen, The Netherlands. 4University of Newcastle upon Tyne, Newcastle upon Tyne, UK. 5Helsinki University Central Hospital, Helsinki, Finland. 6Institut Gustave Roussy, Paris, France. 7Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 8Herlev University Hospital København, Copenhagen, Denmark. 9Organon Teknika BV, Boxtel, The Netherlands. 10Leopold-Franzens Universität Innsbruck, Innsbruck, Austria
The purpose of this nine-centre study in 602 patients was to show that the frequency of acceptable intubating conditions after rapacuronium 2.0 or 2.5 mg kg–1 is not more than 10% lower than the frequency after succinylcholine 1.0 mg kg–1 during rapid-sequence induction of anaesthesia with fentanyl 1–2 µg kg–1 and thiopental 2–7 mg kg–1. Laryngoscopy and intubation were carried out 60 s after administration of muscle relaxant by an anaesthetist blinded to its identity. Intubating conditions were clinically acceptable (excellent or good) in 91.8% of patients given succinylcholine and in 84.1 and 87.6% of patients given rapacuronium 2.0 and 2.5 mg kg–1 respectively. With respect to the percentage of clinically acceptable intubating conditions, the estimated difference (and the upper limit of the one-sided 97.5% confidence interval) between succinylcholine and rapacuronium 2.0 mg kg–1 was 7.8 (14.4)% and between succinylcholine and rapacuronium 2.5 mg kg–1 it was 4.0 (10.2)%. For both comparisons, the upper limit of the one-sided confidence interval exceeded the predefined 10% difference. Hence, it could not be demonstrated that the intubating conditions with either of the two doses of rapacuronium were not inferior to those with succinylcholine 1.0 mg kg–1. The increase in heart rate was significantly greater during the first 5 min in the rapacuronium groups, but the arterial pressure increased significantly only in the succinylcholine group (P<0.001). Respiratory side-effects were observed in 4.0, 13.5 and 18.5% of patients after succinylcholine and rapacuronium 2.0 and 2.5 mg kg–1 respectively (P<0.05). As the non-inferiority of intubating conditions after rapacuronium 2.0 and 2.5 mg kg–1 could not be proven, succinylcholine should be considered the neuromuscular blocking agent that provides better intubating conditions for rapid-sequence induction.
Br J Anaesth 2000; 85: 724–31
* Corresponding author: Klinik für Anaesthesiologie der Technischen Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, D-81675 München, Germany
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