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LETTER TO THE EDITOR

Airway Injury with Low-Dose Rocuronium Versus Succinylcholine for Rapid-Sequence Induction: Relevance and Ethics

Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Rostock, Germany, thomas.mencke{at}uni-rostock.de or thomas.mencke{at}googlemail.com (Mencke, Noeldge-Schombur) Department of Anaesthesia and Intensive Care Medicine, University of the Saarland, Homburg/Saar, Germany (Knoll)

In Response:

Dr. Wax questions (1) whether our study (2) provides clinically relevant information. Our aim was to define the incidence and severity of hoarseness, sore throat, and vocal cord injuries in patients receiving succinylcholine or rocuronium for rapid-sequence induction. Our first study (3) showed that excellent intubating conditions were associated with the lowest incidence of laryngeal morbidity. We wanted to determine if these results could be transferred to an emergency rapid-sequence induction.

Our results indicate that laryngeal morbidity does not correlate with the intubating conditions during rapid-sequence induction. Because this study was done under real rapid-sequence inductions, the results are clinically relevant. Although succinylcholine produced better intubating conditions, the incidence of tracheal injury was similar in both groups.

The rocuronium package insert (July 2005) states that 0.6–1.2 mg/kg is the appropriate dose for rapid-sequence induction. Our dosing and terminology are consistent with the package insert. The package insert defines "low dose" rocuronium as a dose of 0.45 mg/kg. Dr. Wax’s characterization of our dose as "low" is inconsistent with rocuronium’s product labeling.

REFERENCES

1. Wax DB. Airway injury with low-dose rocuronium versus succinylcholine for rapid-sequence induction: relevance and ethics. Anesth Analg 2007;104:210.[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. Mencke T, Echternach M, Kleinschmidt S, et al. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology 2003;98:1049–56.[Web of Science][Medline]

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