Larsen P B, Hansen E G, Jacobsen L S, Wiis J, Holst P, Rottensten H, Siddiqui R, Wittrup H, Sørensen A M, Persson S, Engbaek J
University of Copenhagen, Department of Anaesthesiology, Herlev Hospital, Glostrup, Denmark.
Eur J Anaesthesiol. 2005 Oct;22(10):748-53. doi: 10.1017/s0265021505001249.
Previous studies mainly conducted on elective patients recommend doses of 0.9-1.2 mg kg[-1] rocuronium to obtain comparable intubation conditions with succinylcholine 1.0 mg kg[-1] after 60 s during a rapid-sequence induction. We decided to compare the overall intubating conditions of standard doses of rocuronium 0.6 mg kg[-1] and succinylcholine 1.0 mg kg[-1] during a strict rapid-sequence induction regimen including propofol and alfentanil.
Male and female patients (ASA I-III) older than 17 yr scheduled for emergency abdominal or gynaecological surgery and with increased risk of pulmonary aspiration of gastric content were randomized to a rapid-sequence induction with succinylcholine 1.0 mg kg[-1] or rocuronium 0.6 mg kg[-1]. Patients with a predicted difficult airway were excluded. A senior anaesthesiologist 'blinded' for the randomization performed the intubation 60 s after injection of the neuromuscular blocker. Intubating conditions were evaluated according to an established guideline. Tracheal intubation not completed within 30 s was recorded as failed.
222 patients were randomized. Three patients had their operation cancelled and 10 did not fulfil the inclusion criteria. Clinically acceptable intubation conditions were present in 93.5% and 96.1% of patients in the succinylcholine group (n=107) and the rocuronium group (n=102), respectively (P=0.59).
During a rapid-sequence induction with alfentanil and propofol, both rocuronium 0.6 mg kg[-1] and succinylcholine 1.0 mg kg[-1] provide clinically acceptable intubation conditions in 60 s in patients scheduled for emergency surgery. Under the conditions of this rapid-sequence induction regimen rocuronium may be a substitute for succinylcholine.
既往针对择期手术患者的研究推荐使用0.9 - 1.2毫克/千克的罗库溴铵剂量，以便在快速序贯诱导60秒后获得与1.0毫克/千克琥珀胆碱相当的插管条件。我们决定在包括丙泊酚和阿芬太尼的严格快速序贯诱导方案中，比较0.6毫克/千克标准剂量罗库溴铵与1.0毫克/千克琥珀胆碱的总体插管条件。
年龄大于17岁、计划进行急诊腹部或妇科手术且胃内容物肺误吸风险增加的男性和女性患者（美国麻醉医师协会分级I - III级）被随机分为接受1.0毫克/千克琥珀胆碱或0.6毫克/千克罗库溴铵的快速序贯诱导组。预计气道困难的患者被排除。一名对随机分组不知情的资深麻醉医师在注射神经肌肉阻滞剂60秒后进行插管。根据既定指南评估插管条件。30秒内未完成气管插管记录为失败。
222例患者被随机分组。3例患者手术取消，10例未符合纳入标准。琥珀胆碱组（n = 107）和罗库溴铵组（n = 102）分别有93.5%和96.1%的患者具备临床可接受的插管条件（P = 0.59）。
在阿芬太尼和丙泊酚的快速序贯诱导过程中，0.6毫克/千克罗库溴铵和1.0毫克/千克琥珀胆碱均可在60秒内为急诊手术患者提供临床可接受的插管条件。在该快速序贯诱导方案条件下，罗库溴铵可替代琥珀胆碱。
