A Study of Priming Technique of Rocuronium in Facilitating Intubation

Tracheal intubation is usually performed after induction of anaesthesia followed by relaxation of skeletal muscle with depolarizing or nondepolarizing Neuro Muscuc c lar Block Agent (NMBA). The ability to intubate the trachea rapidly and safely is still paramount in all clinical situations. Suxamethonium is still the drug of choice for this purpose. This short-acting depolarizing NMBA is probably the most popular drug used for making intubation quick, easy and atraumatic. But this drug has many side effects like post operative muscle pain, hyperkalemia, malignant hyperthermia, masseter rigidity etc. For these reasons, researchers have concentrated to develop an alternative drug to suxamethonium or an alternative method of using non-depolarizing NMBA (Neuromuscular Blocking Agent) for rapid sequence induction to intubation technique. Rocuronium bromide, an aminosteroid nondepolarizing NMBA, the onset time of which is significantly shorter than equivalent doses of other non-depolarizing NMBA .Priming technique with rocuronium has been investigated by several authors in an attempt to reduce the onset time and also to optimize it's efficacy and reduce the incidence of side-effects. This study was performed to investigate the influence of priming technique on the intubating time and intubation conditions with standard intubating dose of rocuronium (0.6 mg/kg), which may be comparable with standard intubation dose of suxamethonium (1.5 mg/kg). Thus using priming technique Rocuronium with standard intubating dose (0.6 mg/kg) may be suitable alternative to suxamethonium for rapid sequence induction of anaesthesia. So, we can avoid many life-threatening side-effects associated with suxamethonium like, hyperkalemia, massater spasm, malignant hyperthermia and we can also avoid mega-dose of rocuronium (0.9-1.2 mg/kg) used for same purpose. A total number of 90 adult subjects, aged 18-45 yr, ASA I-II, undergoing elective surgery were studied. The selected patients were equally divided into three groups, 30 patients in each group.Following induction with thiopentone (5mg/kg) and Fentanyl (2?gm/kg), patients in group-I (n=30) received suxamethonium 1.5 mg/kg, group-II (n=30) received a priming dose of rocuronium 0.06 mg/ kg followed 3 minutes later by an intubating dose of 0.54 mg/kg and group-III (n=30) received rocuronium 0.6 mg/kg in single bolus injection. Neuromuscular function was assessed at the wrist using acceleration transducer (TOF-watch). In priming group any