Is the rapid sequence induction possible with 0.6 mg/kg rocuronium in pediatric patient? / 대한마취과학회지

BACKGROUND: We have investigated the possibility of rocuronium 0.6 mg/kg and timing principle application with the same dose for rapid sequence induction (RSI) in 65 children, aged 4-8 yr. METHODS: Sixty five patients were randomly assigned to one of two groups; Group A (n = 31, timing principle application) received rocuronium (0.6 mg/kg) followed by administration of propofol (2.5 mg/kg), and group B (n = 36) received rocuronium (0.6 mg/kg) after administration of propofol. Intubation was assessed at 60 seconds just after administration of last injectants. Intubating conditions (jaw relaxation, vocal cord movement, and response to tracheal intubation) were evaluated as excellent, good, fair and poor. RESULTS: Excellent intubation conditions were obtained in 87% in group A and 61% in group B. However, clinically acceptable intubation conditions which means excellent and good did not show any significant difference as 100% (group A) and 99% (group B). CONCLUSIONS: In cases of pediatiric patients undergoing elective surgery, RSI was possible irrespective of the use of timing principle.

The effect of priming with rocuronium on onset time and intubation conditions during endotracheal intubation with low-dose rocuronium / 대한마취과학회지

BACKGROUND: A priming dose of rocuronium can shorten the onset time of neuromuscular blockade. The purpose of this study was to evaluate the effect of priming with rocuronium on the onset time and intubation conditions during tracheal intubation with low-dose rocuronium (0.35 mg/kg) and to compare results with those for rocuronium 0.45 mg/kg. METHODS: One hundred twenty four patients were randomly allocated to three groups. Following induction of anesthesia, groups I and III received normal saline while group II received a priming dose of rocuronium (0.05 mg/kg). Three minutes after priming, groups I, II and III received, respectively, 0.45 mg/kg, 0.3 mg/kg and 0.35 mg/kg rocuronium. Intubation was performed 2 minutes after the administration of an intubating dose and intubation conditions were evaluated. Neuromuscular blockade was assessed by accelerography. RESULTS: The proportion of cases having optimal intubation conditions in group I was higher than in groups II and III. There was no significant difference in the onset times among groups. Neuromuscular blockade at 60, 90 and 120 seconds after an intubating dose was similar among all groups except at 60 sec. Maximal blockade for group I was deep compared to groups II and III. CONCLUSIONS: Rocuronium 0.35 mg/kg does not provide satisfactory intubation conditions. There are no effects on onset time and intubation conditions due to priming during tracheal intubation with rocuronium 0.35 mg/kg.

Is 0.6 mg/kg of succinylcholine adequate for tracheal intubation in Korean? / 대한마취과학회지

BACKGROUND: The usual dose of succinylcholine for tracheal intubation is 1.0 mg/kg. If the patient is not ventilated by face mask after administration of the succinylcholine (1.0 mg/kg), the patient may experience significant hemoglobin desaturation. The purpose of the present study was to evaluate an appropriate dose of succinylcholine for tracheal intubation in Korean. METHODS: Sixty patients scheduled for elective surgery were randomly divided into three groups; group I (succinylcholine 0.3 mg/kg, n = 20), group II (succinylcholine 0.6 mg/kg, n = 20), group III (succinylcholine 1.0 mg/kg, n = 20). All patients were not premedicated. After loss of consciousness, the patients received succinylcholine 0.3, 0.6, 1.0 mg/kg, respectively. The contraction responses of the adductor pollices muscle were monitored by using TOF. Tracheal intubation was accomplished as the height of T1 was inhibited maximally. Then, intubation scores were recorded. The recovery times from neuromuscular blockade in groups II and III were also measured. RESULTS: The acceptable conditions for tracheal intubation were 30%, 100%, and 100%, respectively in groups I, II, and III. The onset time was 80.4 +/- 15.5 sec, 69.6 +/- 13.1 sec, and 56.1 +/- 9.3 sec, respectively. The recovery time (T1 = 90%) was 446.0 +/- 86.2 sec, 694.0 +/- 84.7 sec, respectively in groups II and III. The onset time was the fastest in group III. But the recovery time in group III was slower than in group II. CONCLUSIONS: We concluded that 0.6 mg/kg of succinylcholine is an appropriate dose for tracheal intubation in Korean except for rapid sequence intubation.

Effect of mixed administration of propofol and rocuronium on intubating conditions / 대한마취과학회지

BACKGROUND: We investigated whether the intubating condition change acoording to the methods of administration of propofol and rocuronium. METHODS: Ninety adult patients (ASA physical status I or II) undergoing elective surgery were randomly assigned to one of three groups; Group I (n = 30) received rocuronium (0.6 mg/kg) after administration of propofol (2 mg/kg), Group II (n = 30) received propofol and rocuronium simultaneously via different intravenous routes, and Group III (n = 30) received a mixture of propofol and rocuronium via same intravenous route. Intubation was attempted at 60 seconds after administration of rocuronium. Hemodynamic parameters (mean blood pressure, heart rate) were measured before and after propofol administration with 20 seconds interval. Intubating conditions (jaw relaxation, vocal cord movement, and response to tracheal intubation) were evaluated as excellent, good, fair and poor. Train of four counts were recorded at 60 seconds after administration of rocuronium. RESULTS: Excellent intubating conditions were obtained in 13% in group I, 60% in group II, 77% in group III. Mean train of four counts were 3.7 in group I, 3.4 in group II, and 3.5 in group III. Mean blood pressures were decreased gradually after propofol administration in all groups. However, heart rates were not changed in all groups. CONCLUSIONS: At induction of anesthesia, simultaneous or mixed administration of propofol and rocuronium provides excellent or good intubating conditions 60 seconds after rocuronium administration. It could be an effective alternative to succinylcholine for rapid sequence induction of anesthesia.

The Effect of Combined Ephedrine and Lidocaine Pretreatment on Tracheal Intubation Condition and Maximum Neuromuscular Block after Rocuronium Administration / 대한마취과학회지

BACKGROUND: Rocuronium is a nondepolarizing muscle relaxants used for trying rapid-sequence intubation due to its relatively rapid onset of action and low side effects. Methods to further reduce the onset time of a muscle relaxant include increasing the dose of muscle relaxant, pretreatment for potentiating neuromuscular block of the muscle relaxants or increasing the cardiac output and muscle blood flow. The purpose of this study was to examine the pretreatment effect of combined lidocaine and ephedrine, as a pretreatment, on the onset time and intubation conditions of rocuronium-induced neuromuscular block in adults. METHODS: Sixty ASA physical stati 1 and 2 patients were randomly allocated to four groups. Normal saline 10 ml was administered to Group NS prior to induction, lidocaine (1.5 mg/kg) to Group L, ephedrine (70microgram/kg) to Group E, and combined lidocaine (1.5 mg/kg) and ephedrine (70microgram/kg) to Group LE. Anesthesia was induced with propofol (2.0 mg/kg) and rocuronium (0.6 mg/kg). Intubation was performed 45 seconds after the administration of rocuronium and the intubation conditions then evaluated. The change in the mean arterial pressure and heart rate were checked and compared during the peri-induction periods. RESULTS: There were no differences in the hemodynamics between the four groups. The intubation conditions were graded as good to excellent in 33.3, 53.3, 66.7 and 93.3% of patients in NS, L, E and LE groups, respectively. The intubation conditions in group LE were significantly better than those in group NS (P < 0.05). CONCLUSIONS: The above results demonstrated that pretreatment with a combination of ephedrine and lidocaine, following rocuronium, improves the tracheal intubation conditions.

Effect of Low-dose Rocuronium on Tracheal Intubating Conditions during Induction of 8 vol% Sevoflurane with Remifentanil

BACKGROUND: We evaluated the effect of low doses of rocuronium on tracheal intubating conditions and hemodynamic changes during induction of anesthesia with 8 vol% sevoflurane and remifentanil 1microg/kg. METHODS: Eighty four patients were randomized into one of three groups; Group I, II, III. Each group received normal saline, 0.3, 0.45 mg/kg of rocuronium respectively. Predetermined drugs for each group and remifentanil 1microg/kg were administered during induction of 8 vol% sevoflurane. After induction of 8 vol% sevoflurane, tracheal intubation was preformed. The tracheal intubation conditions and hemodynamic responses to tracheal intubation were assessed. RESULTS: Tracheal intubation was successful in all patients. The incidence of clinically acceptable intubating conditions was 79% in Group I, 100% in Group II, and 100% in Group III. There was no significant difference in intubating condition between Group II and Group III. The hemodynamic responses to tracheal intubation were blunted in all groups. CONCLUSIONS: After induction with 8 vol% sevoflurane and remifentanil 1microg/kg, low-dose rocuronium provides more satisfactory tracheal intubation conditions.

Comparison of Induction Drugs and Timing on Intubation Conditions Using Rocuronium / 대한마취과학회지

BACKGROUND: Sevoflurane has been reported to potentiate the effect of rocuronium. We compared the effect of sevoflurane and propofol on intubating conditions and their corresponding hemodynamic changes, and also compared the intubation conditions at different intubation timing using the rocuronium. METHODS: Sixty patients were randomized into four groups: group P (P-60, P-90) received 10 mg/kg/hr of propofol after 2 mg/kg of bolus injection; group S (S-60, S-90) were inhaled with 8 vol% sevoflurane after injection of 50 mg of thiopental sodium. Intubation was attempted at either 60 seconds (P-60, S-60) or 90 seconds (P-90, S-90) after the rocuronium administration. Intubation conditions were assessed and evaluated as excellent, good, poor and inadequate. Single twitch responses were measured at every 30 seconds after rocuronium administration. Blood pressure and heart rate were measured before induction, before intubation and immediately after intubation. RESULTS: Excellent and good intubation conditions were obtained in 60% (n = 9) of group P-60, 73% (n = 11) of group S-60, 92% (n = 14) of group P-90 and 100% (n = 15) of group S-90. Single twitch responses were fewer in group P-90 and S-90 compared to those in group P-60 and S-60 (P < 0.01). Blood pressure and heart rate after intubation were elevated in all four groups. CONCLUSIONS: Intubation conditions were not significantly different between inhalation of sevoflurane and intravenous administration of propofol when using rocuronium. Prolonged interval between rocuronium administration and intubation resulted in improved intubation conditions.

Effects of Intravenous Induction Drugs on Intubation Conditions Using Rocuronium for Rapid Sequence Induction / 대한마취과학회지

BACKGROUND: We assessed the effect of intravenous induction agents on intubation conditions and hemodynamic changes when using rocuronium 0.7 mg/kg for rapid sequence induction. METHODS: Sixty ASA class I or II patients undergoing elective surgery were divided into a thiopental group (5 mg/kg, n = 20), a propofol group (2 mg/kg, n = 20) and an etomidate group (0.2 mg/kg, n = 20). Anesthesia was induced with intravenous induction agents. After loss of consciousness, rocuronium 0.7 mg/kg was injected. Intubation was attempted at 60 seconds after rocuronium administration. Arterial blood pressure and heart rate were measured before induction, immediately after intubation, and 1, 3, 5, and 10 minutes after intubation. Intubation conditions were assessed by jaw relaxation, vocal cord movement, response to tracheal intubation, and were evaluated as excellent, good, fair, and poor. RESULTS: Excellent intubation conditions were obtained 55% (n = 11) in the thiopental group, 60% (n = 12) in the propofol group, and 45% (n = 9) in the etomidate group. Systolic and diastolic arterial blood pressures were elevated after intubation in all three groups. But these changes were minimal in the propofol group. CONCLUSIONS: Intubation conditions were not significantly different after the intravenous injection of thiopental 5 mg/kg, propofol 2mg/kg, or etomidate 0.2 mg/kg when using rocuronium 0.7 mg/kg for rapid sequence induction.

Comparison of Tactile DBS and TOF Fade Evaluated Intubation Conditions after Vecuronium Administration / 대한마취과학회지

The tactile DBS and TOF fade evaluated intubation conditions under the neuromuscular blockade induced with vecuronium was studied in 40 cases who were ASA 1 or 2 adult patients. All patients were premedicated with glycopyrrolate 0.2 mg and hydroxyzine 1 mg/kg 1 hour before induction, and inducted with thiopental sodium 5 mg/kg, O2-N2O(50%) and enflurane(2%). The patients were randomly divided to two groups according to the mode of nerve stimulation: TOF group(n=20) and DBS group(n=20). Neuromuscular blockade was monitored by stimulation of the ulnar nerve at the wrist using INNERVATOR(fisher & Paykel Co.). For both stimulation patterns the frequencies of manually detectable fade in the response to stimulation were undetectable fade in both group after vecuronium(0.1mg/kg) injection intravenousely. The response of tracheal intubation was appreciated based on vocal cord reflex, coughing or barking, and jaw relaxation. The time from administration of vecuronium to undetectable fade was 214.2+/-68.5 in TOF group and 250.2+/-51.8 in DBS group but no statistical difference. In addition, intubation conditions in DBS group were little better than in TOF group but it was also no significant. Conclusively, there was no different between TOF and DBS fade to evaluate the intubation conditions under the neuromuscular blockade induced with vecuronium.

Comparison of Tactile DBS and TOF Fade Evaluated Intubation Conditions after Vecuronium Administration / 대한마취과학회지

The tactile DBS and TOF fade evaluated intubation conditions under the neuromuscular blockade induced with vecuronium was studied in 40 cases who were ASA 1 or 2 adult patients. All patients were premedicated with glycopyrrolate 0.2 mg and hydroxyzine 1 mg/kg 1 hour before induction, and inducted with thiopental sodium 5 mg/kg, O2-N2O(50%) and enflurane(2%). The patients were randomly divided to two groups according to the mode of nerve stimulation: TOF group(n=20) and DBS group(n=20). Neuromuscular blockade was monitored by stimulation of the ulnar nerve at the wrist using INNERVATOR(fisher & Paykel Co.). For both stimulation patterns the frequencies of manually detectable fade in the response to stimulation were undetectable fade in both group after vecuronium(0.1mg/kg) injection intravenousely. The response of tracheal intubation was appreciated based on vocal cord reflex, coughing or barking, and jaw relaxation. The time from administration of vecuronium to undetectable fade was 214.2+/-68.5 in TOF group and 250.2+/-51.8 in DBS group but no statistical difference. In addition, intubation conditions in DBS group were little better than in TOF group but it was also no significant. Conclusively, there was no different between TOF and DBS fade to evaluate the intubation conditions under the neuromuscular blockade induced with vecuronium.

The Effect of Small Dose of Nondepolarizing Muscle Relaxant Administered Prior to Succinylcholine on Intubating Condition / 대한마취과학회지

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.

The Effect of Small Dose of Nondepolarizing Muscle Relaxant Administered Prior to Succinylcholine on Intubating Condition / 대한마취과학회지

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.

Relationship between the Change of PTC and the Response of Endotracheal Intubation after Vecuronium Induction / 대한마취과학회지

The relationship between the post-tetanic count(PTC) and the response of tracheal intubation after vecuronium-induced neuromuscular blockade was studied in 99 cases who were ASA 1 or 2 adult patients. All patients were premedicated with glycopyrrolate 0.2mg and hydroxizine 1 mg/kg IM 1 hour before induetion, and were inducted with pentothal sodium Smg/kg and O2- N2O(50%) enflurane(2%). The patients were randomly divided to two groups according to dose of vecuronium applied after inducion ; 0.08 mg/kg(n=54) group and 0.12 mg/kg(n=45) group. Neuromuscular blockade was monitored by stimulation of the ulnar nerve at the wrist with single twitch using INNERVATOR(Fisher and Paykel Co.). Post tetanic count(PTC) was counted at different times, i.e., 0, 10, 20, 25, 30 and 35 seconds, 9 persons respectively at each time, after disappearance of single twitch. Tracheal intubation was performed immediately after counting of PTC. The response of tracheal intubation was appreciated based on vocal cord reflex, coughing or barking and patient movement. The time from administration of vecuronium to disappearance of single twitch was 167.8+/-23.4 seconds in 0.08mg/kg group and 163.7+/-51.1 seconds in 0.12mg/kg group and there was no statistical difference. After complete disappearance of single twitch, the PTC was zero at 35 seconds in 0.08 mg/kg group and at 25 seconds in 0. 12 mg/kg group. While the PTC was lowering, the lower intubation condition score should be expected, but the 0 of PTC did not coin-cided with the 0 of intubation condition score. However, the 0 of PTC did not always indicated that response to tracheal intubation could be disappear completely. Profound neuromuscular blockade did not reduce the hemodynamic responses to tracheal intubation.