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LETTER TO THE EDITOR

Rapid-Sequence Induction: Rocuronium or Suxamethonium?

Post Doctoral Researcher (Mencke) Department of Anaesthesia and Intensive Care Medicine; University of Rostock; Rostock, Germany; thomas.mencke{at}uni-rostock.de (Noeldge-Schomburg) Department of Anaesthesia and Intensive Care Medicine; Catholic Hospital; Koblenz, Germany (Silomon)

In Response:

We appreciate Dr. Tornero-Campello’s comments (1) on our study (2), and we would like to respond to his letter. In their meta-analysis, Perry et al. (3) compared intubation conditions created by rocuronium versus succinylcholine during rapid-sequence induction (RSI). They found that succinylcholine more often produced excellent intubating conditions than rocuronium did. However, the two drugs did not differ statistically in creating clinically acceptable intubating conditions. However, the small study size may have lacked the power to separate the ability of the two drugs to produce acceptable intubation conditions.

Indeed, Andrews et al. (4) showed that increasing the rocuronium dose from 0.6 to 1.0 mg/kg significantly increased the incidence of excellent and clinically acceptable intubating conditions. Heier and Caldwell (5) achieved a 90% probability of achieving perfect and excellent intubating conditions for RSI with large (up to 2.0 mg/kg) rocuronium doses. If the rocuronium doses used in our study had exceeded 0.6 mg/kg, our incidence of clinically acceptable or excellent intubating conditions might have been similar to that of succinylcholine. When Org 25969 (sugammadex) becomes commercially available, the clinician will be able to rapidly terminate rocuronium’s effects, if faced with a "cannot intubate, cannot ventilate" situation. However, because Org 25969 is not available yet, we have to use succinylcholine to manage those clinical settings that require excellent intubating conditions. Only succinylcholine provides uniformly predictable onset times and a short duration of action.

REFERENCES

1. Gonzalo T-C. Rapid-sequence induction: rocuronium or suxamethonium? Anesth Analg 2006;103:1579.[Free Full Text]
2. 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]
3. Perry JJ, Lee J, Wells G. Are intubation conditions using rocuronium equivalent to those using succinylcholine? Acad Emerg Med 2002;9:813–23.[Web of Science][Medline]
4. Andrews JI, Kumar N, van der 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]
5. Heier T, Caldwell JE. Rapid tracheal intubation with large-dose rocuronium: a probability-based approach. Anesth Analg 2000;90:175–9.[Abstract/Free Full Text]

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