Comparison of Methods to Facilitate Rapid Sequence Intubation

Study Overview
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Brief Summary
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In this study, methods which are known for facilitating rapid sequence intubation or accelerating rocuronium (Roc)onset are compared including magnesium (Mg), ketamine pretreatment, large dose rocuronium and priming.

Detailed Description
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Patients are pretreated with Mg, ketamine, or priming dose Roc. Two groups do not receive pretreatment, but are given Roc 0.6 mg/kg or 0.9 mg/kg.

Official Title
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Comparison of Mg, Ketamine, Large Dose Rocuronium, and Priming on Intubating Condition in Rapid Sequence Intubation

Conditions
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Intubating Condition

Intervention / Treatment
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* Drug: Magnesium Sulfate
* Drug: Ketamine
* Drug: rocuronium


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age 18 - 65 years, ASA 1 - 2, patients scheduled for elective surgery under general anesthesia, BMI 18.5-24.9 kg/m2 Mallampati class I-II Exclusion Criteria: neuromuscular disorder, cardiac/hepatic/renal insufficiency, pregnant. anticipated difficult airway medications that influence neuromuscular transmission

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ketamine<br>Patients receive ketamine 0.5 mg/kg 2 min before Roc injection. | Drug: Ketamine<br>* patients receive ketamine 0.5 mg/kg 2 min before Roc injection.<br>|
| Experimental: priming<br>Patients receive Roc 0.06 mg/ kg as a priming dose 3 min before injection of Roc 0.54 mg/kg. | Drug: rocuronium<br>* Patients receive Roc 0.06 mg/ kg as a priming dose 3 min before injection of Roc 0.54 mg/kg.<br>|
| No Intervention: Roc 0.9<br>Patients receive Roc 0.9 mg/kg as an induction dose. | |
| No Intervention: Control<br>Patients receive Roc 0.6 mg/kg without any pretreatments of Mg, ketamine, or priming. | |
| Experimental: Mg<br>Patients receive magnesium sulfate (MgSO4) 50 mg/kg over 10 min before Roc injection. | Drug: Magnesium Sulfate<br>* Patients receive MgSO4 50 mg/kg for 10 min before injection of Roc 0.6 mg/kg.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intubation score | Patients are tracheally intubated, and intubation scores(poor, good,excellent)are rated. | participants will be followed at the time point of intubation, an expected average of 70 sec from the start of rocuronium injection. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Roc duration | Time from the start of rocuronium injection until reappearance of two muscle twitches in TOF stimulations is measured, using ToF-Watch sx. | participants will be followed when TOF count reaches two, an expected average of 40 min. | 
| Roc onset | Time from the start of rocuronium injection until TOF count=0 using TOF-Watch sx. | participants will be followed when TOFcount =0 within an expected average of 4 min from the start of rocuronium injection. | 
| Hemodynamic variables | Mean arterial pressure (MAP)and heart rate (HR) are measured at baseline, before intubation, and 1, 2, 3, 4, 5 min after intubation. | participants will be followed at baseline, before and for 5 min after the intubation, an expected average of 8 min after the start of anesthetic induction. | 
| TOF% at intubation | neumeric value expressed as %, displayed on the monitor of TOF watch-Sx in TOF stimulation (ex. 5% on the display means 95% suppression of T1) | participants will be followed at the time point of intubation, an expected average of 70 sec from the start of rocuronium injection. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rocuronium, magnesium, priming, ketamine, intubation