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GENERAL ARTICLES

Rocuronium Is Not Associated with More Vocal Cord Injuries than Succinylcholine After Rapid-Sequence Induction: A Randomized, Prospective, Controlled Trial

Thomas Mencke, MD^*, Heike Knoll, MD, Jan-Uwe Schreiber, MD, Matthias Echternach, MD, Sarah Klein, MD, Gabriele Noeldge-Schomburg, MD^*, and Malte Silomon, MD^||

*Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Rostock, Department of Anaesthesia and Intensive Care Medicine, Department of Otorhinolaryngology, University of the Saarland, Homburg/Saar, ||Department of Anaesthesia and Intensive Care Medicine, Catholic Hospital, Koblenz, Germany

Address correspondence and reprint requests to Thomas Mencke, MD, Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057 Rostock Germany. Address e-mail to thomas.mencke{at}uni-rostock.de.

Postoperative hoarseness (PH), sore throat (ST), and vocal cord injuries (VCI) are common complications after general anesthesia. Excellent endotracheal intubating conditions are associated with less laryngeal morbidity than good or poor intubating conditions. Thus, we tested the hypothesis that a rapid-sequence induction (RSI) with succinylcholine would lead to less PH and VCI than with rocuronium. In this prospective trial, 160 patients were randomized in 2 groups to receive thiopental 5.0 mg/kg, fentanyl 3.0 µg/kg, succinylcholine 1.0 mg/kg, or rocuronium 0.6 mg/kg during RSI. PH and ST were assessed at 24, 48, and 72 h after surgery, VCI were examined by stroboscopy in those patients who had PH >3 days. Excellent and clinically acceptable intubating conditions were significantly increased in the succinylcholine group compared with the rocuronium group: 57% versus 21% and 89% versus 59%, respectively (P < 0.001). The incidence and severity of PH, and VCI between the succinylcholine and the rocuronium groups did not differ significantly: PH: 50% versus 51% (P = 0.99) and VCI: 3% versus 1% (P = 0.98), respectively. Similar findings were found for ST, 39% versus 28% (P = 0.22), and postoperative myalgia, 39% versus 29% (P = 0.25), respectively. Intubating conditions were significantly better in the succinylcholine group compared with the rocuronium group. The incidence and severity of ST and myalgia were not increased in the patients receiving succinylcholine. However, the rate of PH and VCI was similar to the rocuronium group.

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