Comparison of Intubating Conditions with 0.6 mg/kg and 0.9 mg/kg Rocuronium Bromide for Rapid Sequence Intubation

Introduction: Dose of rocuronium bromide usually used for rapid sequence intubation (RSI) allows rapid paralysis but the duration of action is prolonged making it unsuitable for short duration surgeries. Theoretically, use of low doses of neuromuscular blocking agents shortens the time for recovery from neuromuscular blockade (NMB). Hence we studied the intubating conditions of rocuronium bromide at 2 × ED95 dose (0.6 mg/kg) in comparison with 3 × ED95 dose (0.9 mg/kg). Methods: Sixty patients aged 18-60 years, ASA PS 1 and 2 posted for elective surgeries requiring GA with endotracheal intubation were studied. Patients were randomized into two groups of 30 each (Group A and B), to receive either 0.6 mg/kg rocuronium bromide or 0.9 mg/kg rocuronium bromide. Intubating condition was assessed at 60 seconds. Onset and clinical duration were recorded and data analysed using independent sample t-test and chi-square analysis. Results: There was a significant difference in the intubating conditions between the groups (p=0.001) with 28 patients (93.3%) having excellent intubating conditions and 2 (6.6%) having good intubating conditions in Group B whereas 16 patients (53.3%) had excellent intubating conditions and 12 (40%) had good intubating conditions in Group A. None had inadequate conditions for intubation. There was significant difference (p<0.0001) between the mean clinical duration of NMB in group A (29.37 min ± 5.73 min) and Group B (50.10 min ± 6.69 min). Conclusion: We concluded that rocuronium bromide at 0.9 mg/kg provided good to excellent intubating conditions at 60 seconds but at the cost of prolonged duration of NMB. Whereas rocuronium bromide at 0.6 mg/kg provided adequate intubating conditions for RSI at 60 seconds and hence could be used at this dose in situations where succinylcholine is contraindicated and a shorter duration of NMB is preferred.