TITLE: ROCURONIUM VERSUS SUCCINYLCOLINE IN EMERGENCY CRITICALLY ILL SURGICAL PATIENTS

AUTHORS: Florea O. Purcaru, MD, PhD, Pantelie Nicolcescu, MD, Gabriela Manole, MD, Mihnea Tuta, MD, Gabriela Boborelu, MD
AFFILIATION: University Hospital No. 1, Craiova, Romania.

OBJECTIVE: The aim of this prospective study was to assess the onset and quality of muscle paralysis, intubation conditions and hemodinamique changes in emergency critically ill surgical patients.
PATIENTS AND METHODS: 30 critically ill (APACHE III- score > 50 points in the first hour after admission) patients, aged 69-83 years, ASA physical status III-IV E, scheduled for emergency surgical procedures were enrolled in this study. All patients had a normal airway. Anesthesia was induced with Thiopental 2, 5-3, 5mg/kg.15 patients received Rocuronium 0, 9mg/kg and 15 patients received Succinylcoline 1mg/kg. No other sedative or analgesics were administered before induction. No patients had neuromuscular disease, contraindication to Succinylcoline, medication known to influence neuromuscular function, but all patients had an increased risk of pulmonary aspiration. The train of four monitor (TOF-GUARD) and routine monitors were used. Statistical analysis of the data was performed using Student t test and Fisher t exact test (p<0, 05)- statistical significance.
RESULTS: Both groups were demographically similar (age, sex, weight, cardiovascular disease) and there was no significant difference in the thiopental doses. There was no significant difference in time of onset of apneea and in intubation time for Rocuronium (41,9/+3,7)s or Succinylcoline (40,3/+3,1)s. Intuba- tion conditions were found good (jaw relaxed, slight cough) or excellent (no movement, jaw relaxed, cords abducted) in all patients. The HR decreased (3 patients) or increased (3 patients) significantly after Succinylcoline injection. In this group 4 patients presented ventricular extrasistolia or other aritmia comparatively with 3 patients in Rocuronium group.
CONCLUSIONS: Rocuronium (0,9mg/kg) and Succinylcoline (1mg/kg) provide comparatively conditions for accomplishing intubation. After the Succinylcoline we observed significant change in HR in emergency critically ill patients comparative with Rocuronium.
REFERENCES:

Br J Anaesth 1998, 80, 417-9.

Anesthesiology 1993, 79, 913-8.

Anesth Analg 1992, 75, 37-40.