A randomized controlled double blind study on quick intubation regimen using vecuronium priming infusion technique with the use of patient controlled analgesia pump vs bolus priming technique.

ABSTRACT

BACKGROUND & OBJECTIVES: Priming principle is implied to hasten intubation with the use of vecuronium. Priming dose is usually injected by bolus and certain side effects have been observed due to acute rise in plasma levels after bolus injection. In the present study priming infusion regimen of vecuronium using patient controlled analgesia (PCA) pump was compared for the intubation dose onset, intubation, and the side effects with the usual bolus priming. METHODS: Adult ASA grade 1 patients of both sexes (n=112) were randomized into four groups of 28 patients each. In group 1 patients, vecuronium (10 microg/kg) was given bolus (30 sec). In group 2, priming infusion (5 microg/kg/min) regimen for vecuronium (1200 microg/kg) was used by setting up the background infusion rate (ml/h) at 1/4th of the patient body weight on PCA pump. Priming infusion for 3 min delivered the priming dose (15 microg/kg). In group 3, higher priming infusion (10 microg/kg/min) was given by setting up the PCA pump at the 1/2 the patient body weight for 1.5 min, to deliver same dose (15 microg/kg). In group 4, the priming infusion (10 microg/kg/min) for 2 min delivered higher priming dose (20 microg/kg). After induction of anaesthesia with fentanyl, propofol, the intubating dose of vecuronium (0.06 mg/kg) was injected by activating patient demand button and grading laryngoscopy/intubation after 1 min in each group. RESULTS: In demographically similar patients, the laryngoscopy/intubation was excellent in 53 per cent (group 3) and in 64 per cent patients (group 4) after 1 min of the intubation dose. While in bolus priming (group 1), 50 per cent patients developed ocular side-effects, none had it on priming infusion in groups 2 or 3. Only 2 patients complained of diplopia at the higher priming dose (20 microg/kg) (group 4). INTERPRETATION & CONCLUSION: PCA pump regimen for vecuronium priming infusion significantly shortened the onset of intubation. Side effects from the smaller priming dose by bolus were not seen in priming infusion regimen.