Comparative study of intubating conditions after Rocuronium and Suxamethonium (study of 80 cases)

Rocuronium has been developed as fastest acting non-depolarizing muscle relaxant among currently available non-depolarizing muscle relaxants. It was decided to study two important properties i.e. onset of action and intubating conditions after Suxamethonium a time tested popular short acting depolarizing neuromuscular blocking agent and Rocuronium recently introduced intermediate acting non depolarizing neuromuscular blocking agent, with Thiopentone as the sole anesthetic agent in elective, otherwise healthy adult population. This study was conducted in 80 adult patients, aged between 11-60 years undergoing various surgeries requiring general anaeshesia during the study period and were randomly allocated into two groupsGroup A [Rocuronium bromide, 0.6 mg kg (n = 40)] and Group B [Suxamethonium chloride 1.5 mg kg (n = 40)]. Intubation conditions were rated as excellent in 92.5% and good in 7.5% of the patients who received Rocuronium, and excellent in 100% of the patients who received Suxamethonium. Institute where the work was done: P. D. U. medical college & civil hospital, Rajkot. INTRODUCTION As endotracheal intubations is an integral part of administration of anaesthesia during surgical procedure. Suxamethonium, a depolarizing muscle relaxant with its rapid onset and short duration of action is still relaxant of choice to facilitate endotracheal intubation. In addition to fasciculation, Suxamethonium has got many side effects such as bradycardia and other dysrrhythmias, rise in serum potassium, post operative myalgia, rise in intraocular, intragastric and intracranial pressure, incidences of prolonged recovery in patients with pseudo cholinesterase deficiency and triggering of malignant hyperthermia. Because most of the side effects of Suxamethonium reflect its depolarizing mechanism of action therefore research for ideal neuromuscular blocking agent focused on nondepolarizing type of relaxants which has rapid onset time and offers good to excellent intubating conditions, as rapidly as Suxamethonium and which lacks the above mentioned adverse effects. Rocuronium bromide a newer amino steroidal compound is a derivative of Vecuronium; Rocuronium has a rapid onset time, an intermediate duration of action and rapid recovery with cardiovascular stability, no significant histamine release. Keeping these properties in mind it was decided to study two important properties i.e. onset of action and intubating conditions after Suxamethonium a time tested popular short acting depolarizing neuromuscular blocking agent and Rocuronium recently introduced intermediate acting non depolarizing neuromuscular blocking agent, with Thiopentone as the sole anesthetic agent in elective, otherwise healthy adult population. MATERIALS AND METHODS In this study after taking informed consent 80 adult patients aged between 11 and 60 years, of ASA physical status I or II posted for operative procedure from routine operation lists of Pandit Dindayal Upadhyay Hospital Rajkot were selected randomly for study to observe comparison of intubating conditions after Rocuronium versus Suxamethonium. Mallampatti grade of all patients were I or II. The patients were divided into two groups, each consisting of 40 patients, group A and group B according to neuromuscular blocking agent received. Group A: Rocuronium bromide, 0.6 mg kg (n = 40) Group B: Suxamethonium chloride 1.5 mg kg (n = 40) The criteria for selection of patients were: Comparative study of intubating conditions after Rocuronium and Suxamethonium (study of 80 cases) 2 of 6 Patients were healthy, no other systemic or metabolic disorder. Patients were excluded if they were known to have neuromuscular disease or were receiving medications known to influence neuromuscular function. Patients selected were for laparoscopic surgeries, ear surgery, renal surgery, thyroid surgery and other less than two hours duration for surgery. PREOPERATIVE MANAGEMENT (A)ASSESSMENT OF PATIENT All patients were examined thoroughly and a detailed history was noted. History suggestive of major illness or major surgery and drug therapy was asked. General examination built, nutritional status was examined. Patients were examined for pallor, clubbing, cyanosis; lymphadenopathy, icterus, teeth and spine were also examined. Systemic examination of respiratory system, cardiovascular system, alimentary system, central and peripheral nervous system were carried out to rule out any pathological condition. Patients vital data e.g. temperature, pulse rate per minute blood pressure and respiratory rate were noted. Routine investigations like Hemoglobin estimation, urine for routine & microscopic examinations, blood sugar, blood urea, serum creatinine, chest x-ray, and electrocardiogram were done in all cases. (B)PREPARATION OF PATIENT Patients were kept nil by mouth from 10:00 pm on the day before surgery. On the arrival in operation theatre peripheral venous line was secured, chest leads of cardio scope were attached. After the monitor gadgets application, vital data like pulse rate, blood pressure, spo2 were recorded and noted as before pre-medication data. (C) PREMEDICATION Injection Glycopyrrolate 4g / kg Injection Ranitidine 1 mg / kg Injection Ondansetron 80 g / kg Injection Diclofenac Na 1.5 mg /kg Then pulse, blood pressure, SpO2, ECG was noted as preinduction data. INTRAOPERATIVE MANAGEMENT All patients were pre-oxygenated with 100% O2 with face mask for 3 minutes. Patients were divided into two groups. In Group A: Anaesthesia was induced with inj. sodium Thiopentone 5 mg kg slowly followed by inj. Rocuronium bromide 0.6 mg kg IV. In Group B: Anaesthesia was induced with inj. Sodium Thiopentone 5 mg kg IV slowly followed by inj. Suxamethonium 1.5 mg kg. Time was noted and all vital data recorded along with ECG and SpO2 monitoring. The patients were ventilated with 100% oxygen with intermittent positive pressure ventilation on mask. In both group jaw relaxation and vocal cord relaxation were considered for atraumatic laryngoscopy at 60 seconds or if needed at 75 seconds and then at 90 seconds. Patient was intubated with proper sized endotrachel tube and anesthesia proceeded with O2, N2O, Isoflurane and further doses of muscle relaxant, with use of closed circuit with circle absorber with controlled ventilation. After completion of surgery, reversal of neuromuscular blockade was achieved with injection Neostigmine 0.05 mg kg and Injection Atropine 0.02 mg kg intravenously. After satisfactory recovery, patients were extubated. Post operatively all vital data e.g. pulse, blood pressure, respiratory rate were monitored. And patients were observed for nausea, vomiting, bradycardia, tachycardia, hypotension, respiratory obstruction. Parameters observed: Intubating conditions were assessed using cooper's intubation scoring system The appropriate values were selected and added up to a total numeric score of a maximum of 9.