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LETTER TO THE EDITOR

Rapid-Sequence Induction: Rocuronium or Suxamethonium?

Department of Anesthesiology and Reanimation; Hospital General Universitario de Elche (Spain); Elche (Alicante), Spain; gtorcam{at}hotmail.com

To the Editor:

Dr. Mencke et al. (1) found no difference in the incidence of vocal cord injuries, postoperative hoarseness, or sore throat in patients undergoing rapid-sequence anesthetic induction after administration of succinylcholine 1 mg/kg or rocuronium 0.6 mg/kg. They also used fentanyl 3 µg/kg and thiopental 5 mg/kg. However, the authors did find significantly better intubation conditions using succinylcholine, and concluded that "succinylcholine should be used if excellent intubating conditions are mandatory."

Andrews et al. (2) compared rocuronium 0.6 mg/kg vs 1 mg/kg and found that 1 mg/kg of rocuronium was clinically equivalent to succinylcholine for rapid-sequence induction. They used propofol, which may provide better intubating conditions with rocuronium than thiopental (3). Instead of using higher doses of rocuronium, Yörükoglu et al. (4) found that the combination of lidocaine 1.5 mg/kg and small-dose rocuronium (0.6 mg/kg) along with propofol was clinically equivalent to succinylcholine.

Given these studies, the main reason to use succinylcholine rather than rocuronium is its shorter duration of action, rather than because succinylcholine provides superior intubating conditions. Once Org 25969 (sugammadex) is available to rapidly bind rocuronium and reverse its action, rocuronium may replace succinylcholine for rapid-sequence induction (5).

REFERENCES

1. Mencke T, Knoll H, Schreiber JU, et al. Rocuronium is not associated with more vocal cord injuries than succinylcholine after rapid-sequence induction: a randomized, prospective, controlled trial. Anesth Analg 2006;102:943–9.[Abstract/Free Full Text]
2. Andrews JI, Kumar N, van den Brom RH, et al. A large simple randomized trial of rocuronium versus succinylcholine in rapid-sequence induction of anaesthesia along with propofol. Acta Anaesthesiol Scand 1999;43:4–8.[Web of Science][Medline]
3. Perry J, Lee J, Wells G. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev 2003;1:CD002788.
4. Yorukoglu D, Asik Y, Okten F. Rocuronium combined with IV lidocaine for rapid tracheal intubation. Acta Anaesthesiol Scand 2003;47:583–7.[Web of Science][Medline]
5. Gijsenbergh F, Ramael S, Houwing N, van Iersel T. First human exposure of Org 25969, a novel agent to reverse the action of rocuronium bromide. Anesthesiology 2005;103:695–703.[Web of Science][Medline]

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