Author(s): Viraj Namshikar, Pabitra Ghoshal, Abhinav Pai, Esha Nilekani, Shradha Manjrekar
Rapid sequence induction is performed in patients at risk of aspiration with a short onset muscle relaxant which reduces the time of gastric insufflation before surgery, along with helping in the rapid control of the airway with adequate intubating conditions. Succinylcholine has been most commonly used, alternatively replaced by rocuronium (non-depolarizing muscle relaxant) which has a similar onset of action of one minute. However, succinylcholine cannot be used in all patients because of its various side effects, and rocuronium isn’t available in all centres; in addition to requiring the use of TOF monitoring for muscle paralysis and reversal of the drug. Vecuronium is an intermediate acting non-depolarizing muscle relaxant, with cardio-stable properties, more economical than rocuronium, with an equal potency and in previous studies has been used at a single higher dose to intubate patients in one minute of administration. METHODS A prospective randomized comparative study was conducted in 100 patients scheduled for surgeries under general anaesthesia in the emergency and routine hours of American Society of Anaesthesiologist physical status I and II patients and was divided into two groups of 50 each. Group A received Inj. Vecuronium (0.3 mg/kg) and Group B received Inj. Rocuronium (1.2 mg/Kg) administered as the muscle relaxant after intravenous induction, and the patients were intubated at one minute. Vitals and TOF monitoring were done from preinduction up to 5 minutes after intubation. Intubating conditions were compared using an intubation score, and haemodynamic stability and any side effects were noted along with any significant delay in reversal of the patient at the end of the surgery. Student t test was utilized to compare demographic data, hemodynamic variables and ANOVA was used to evaluate the intubation condition scores and the TOF ratios at 0- and 1-minute intervals. RESULTS The intubating conditions were found favourable and similar in both groups, and TOF values at 1 minute were also similar. Haemodynamic variables were comparable in both groups and no significant side effects were found in either group. CONCLUSIONS Vecuronium can be used as a muscle relaxant for rapid sequence intubations.