Airway Injury with Low-Dose Rocuronium Versus Succinylcholine for Rapid-Sequence Induction: Relevance and Ethics

In Response: Dr. Wax questions (1) whether our study (2) provides clinically relevant information. Our aim was to define the incidence and severity of hoarseness, sore throat, and vocal cord injuries in patients receiving succinylcholine or rocuronium for rapid-sequence induction. Our first study (3) showed that excellent intubating conditions were associated with the lowest incidence of laryngeal morbidity. We wanted to determine if these results could be transferred to an emergency rapid-sequence induction. Our results indicate that laryngeal morbidity does not correlate with the intubating conditions during rapid-sequence induction. Because this study was done under real rapid-sequence inductions, the results are clinically relevant. Although succinylcholine produced better intubating conditions, the incidence of tracheal injury was similar in both groups. The rocuronium package insert (July 2005) states that 0.6–1.2 mg/kg is the appropriate dose for rapid-sequence induction. Our dosing and terminology are consistent with the package insert. The package insert defines “low dose” rocuronium as a dose of 0.45 mg/kg. Dr. Wax’s characterization of our dose as “low” is inconsistent with rocuronium’s product labeling. Thomas Mencke, MD Gabriele Noeldge-Schomburg Department of Anaesthesia and Intensive Care Medicine University of Rostock Rostock, Germany [email protected] or [email protected] Heike Knoll, MD Department of Anaesthesia and Intensive Care Medicine University of the Saarland Homburg/Saar, Germany