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 Combined Use of the Timing Principle and LMA to Secure Airway Patency / 대한마취과학회지

BACKGROUND: The timing principle uses a single bolus dose of nondepolarizing neuromuscular blocker followed by an induction drug to reduce airway patency secure time. If anesthetic depth is adequate, the laryngeal mask airway (LMA) can be inserted with or without a low dose nondepolarizing neuromuscular blocker. So we investigated the combined use of the timing principle and LMA to secure airway patency. METHODS: One hundred and two patients were randomly allocated into three groups. Group RP (n = 34) patients received rocuronium followed by propofol and then a LMA was inserted. Group PR (n = 36) patients received propofol followed by rocuronium and group PS (n = 31) patients received propofol followed by succinylcholine before LMA insertion. Accelerographic response to single twitch and train-of-four (TOF) stimulation were measured. LMA insertional conditions were measured using the degree of jaw relaxation, gagging, cough, and aeration. RESULTS: Single twitch and TOF ratio were lower in the RP group than in the PR group. The LMA insertional conditions were similar for the group RP and PS, but were poor for group PR. One patient in group PR recalled discomfort during LMA insertion. CONCLUSIONS: The combined use of the timing principle and LMA is effective at securing airway patency.

Appropriateness of Administering Rapid Tracheal Intubation with Rocuronium Using the Timing Principle / 대한마취과학회지

BACKGROUND: The "timing principle" utilises a single bolus of nondepolarizing neuromuscular blocking drug followed by an induction drug at the onset of clinical weakness. The purpose of this study was to compare the intubating conditions after succinylcholine or rocuronium and after rocuronium using the timing principle. METHODS: Forty patients were randomly allocated into four groups. Patients in group I received rocuronium 0.6 mg/kg using the timing principle. At the onset of clinical weakness, anesthesia was induced with the thiopental 4-5 mg/kg. Patients in group II, III, and IV received rocuronium 0.6, 0.9 mg/kg, and succinylcholine 1.5 mg/kg respectively using the usual technique. The trachea were intubated 60 s after thiopental induction. Accelerographic response to train-of-four (TOF) stimulation of the ulnar nerve was used for neuromuscular monitoring. Intubating conditions were assessed according to a grading scale. RESULTS: The twitch depression immediately before tracheal intubation in group I, II, III, and IV were 14.5, 28.2, 11.1, and 6.8%, respectively. The TOF count showed no significant differences between groups. The duration of action in group III (45.3 +/- 12.1 min) was significantly prolonged compared to that in group I (31.2 +/- 6.4 min). Intubation conditions were either good or exellent in all patients except one in group II. In group I, three patients recalled shortness of breath or general weakness. CONCLUSIONS: It is concluded that the use of rocuronium 2 X ED95 using the timing principle did not provide additional benefits compared to rocuronium 3 X ED95 using the usual technique except in duration.