Effect of rocuronium compared with succinylcholine on intraocular pressure and intubating conditions during rapid sequence induction of anesthesia

ABSTRACT

Rapid sequence intubation is developed to secure the airway rapidly and safely. Succinylcholine provides excellent intubating conditions and thus remains the muscle relaxant of choice in emergency situation. The aim of this study was to compare the effects of rocuronium and succuinylcholine on intraocular pressure [IOP] during rapid sequence induction of anesthesia using propofol and fintanyl. In addition assessment of intubating conditions after administration of both succinylcholine and rocuronium. In a randomized, double-blind study we studied 40 adult patients, randomly allocated to one of two groups. Anesthesia was induced with fentanyl 2 microg/kg and propofol 2 mg/kg. This was followed by succinylcholine 1.5 mg/kg [group S; n=20] or rocuronium 0.6 mg/kg [group R; n=20]. Laryngoscopy and tracheal intubation were performed 60 seconds later. IOP, mean arterial blood pressure [MAP] and heart rate [HR] were measured before induction, immediately before intubation and every minute after intubation for 5 minutes. Tonopen tonometer was used to measure IOP and the mean of three consequative readings obtained in the right eye at each measurement time was recorded. Simple scoring system was used to evaluate intubating conditions. In the succinylcholine group, IOP was significantly greater than that in rocuronium group mean 23.7 +/- [SEM 1.6] vs mean 14.2 +/- [SEM 0.9] mm Hg; p<0.001. Intubating conditions were similar in both groups. Rocuronium 0.6 mg/kg when used with propofol and fentanyl during rapid sequence induction of anesthesia does not cause a rise in IOP. Thus, it may be a suitable alternative to succinylcholine, especially in cases of penetrating eye injury