Aim To compare the quality of the conditions for endotracheal intubation and muscle relaxation between rocuronium bromide and vecuronium bromide using the ''timing principle'' method for induction in anaesthesia. The "timing principle" includes the administration of muscle relaxants before the hypnotic agent during induction in anaesthesia. Method Sixty patients who had undergone elective surgery were randomly allocated into two equal groups using muscle relaxants: rocuronium (group R) and vecuronium (group V). The intubation conditions were asse ssed using Cooper's scoring system, based on jaw relaxation, vocal cords position and response to intubation. The quality of muscle relaxation was evaluated by recording the time of clinical weakness, a count of ''train of four'' (TOF) twitches at intubation, the time of loss TOF response and duration of direct laryngoscopy. Results The intubation conditions were excellent in 100% of patients in the group R versus excellent in 80% and good in 20% of patients in the group V (p<0.05). The time of clinical weakness was statistically significantly shorter in the group R than in the group V (p<0.000). The time of loss of TOF response was statistically significantly shorter in the group R (p<0.000). The absence of TOF twitches (the level of muscle relaxation of 100%) at intubation recorded in 25 (83.3%) patients in the group R versus five (16.7%) patients in the group V (p<0.000). Duration of direct laryngoscopy did not significantly differ between the groups. Conclusion Rocuronium bromide provides better intubation conditions and greater quality of muscle relaxation than vecuronium bromide using ''timing principle'' technique.
Laurin E, Sakles J, Panacek E, Rantapaa A, Redd J. A comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients. Acad Emerg Med 2000:1362–9.
2
Prabhakar H, Singh G, Ali Z, Kalaivani M, Smith M. Pharmacological and non-pharmacological interventions for reducing rocuronium bromide induced pain on injection in children and adults. Cochrane Database Syst Rev 2016.
3
Ahmad N, Choy C, Aris E, Balan S. Preventing the withdrawal response associated with rocuronium injection: a comparison of fentanyl with lidocaine. Anesth Analg 2005:987–90.
4
Kamalakannan M, Sunder P. A comparative study to evaluate the effectiveness of timing principle and priming principle for tracheal intubation using rocuronium. Ind J Clin Anaesth 2017:512–7.
5
Kumar A, Suchetha S. Comparision of intubating conditions at 60 seconds with different doses of rocuronium using the timing principle. J Anesth Clin Res 2018:815.
6
Babu A, Chaitanya A. Comparison of intubating conditions following administration of rocuronium and succinylcholine: a prospective randomized controlled study. IJSR 2018:21–2.
7
Bhandari R, Verma A, Singh R, Agrawal M, Mitra S, Krishan G. A clinical evaluation of the intubating conditions using two different doses of rocuronium and its comparison with succinylcholine for rapid sequence induction: a prospective single blind study. IJCMR 2018:34–9.
8
Mohanty A, Mohanty R, Routray S, Sahoo S. Comparison of intubating conditions of rocuronium bromide and vecuronium bromide in thyroid surgery using train of four. JMSCR 2018:104–10.
9
Shajahan I, Ramkumar V. Tracheal intubation with rocuronium bromide using the “timing principle” -a comparison with succinyl choline for rapid sequence induction. Ind J Resp Care 2014:364–9.
10
Chatrath V, Singh I, Chatrath R, Arora N. Comparison of intubating conditions of rocuronium bromide and vecuronium bromide with succinylcholine using "timing principle. J Anaesthesiol Clin Pharmacol 2010:493–7.
11
Shareef S, Sudharani G. Comparative study of Succinylcholine, Rocuronium and Vecuronium for intubation and hemodynamic changes during general anaesthesia. IOSR-JDMS 2015:14–9.
12
Parasa M, Vemuri N, Shaik M. Comparison of equipotent doses of rocuronium and vecuronium. Anesth Essays Res 2015:88–91.
13
Vishwas S, Sivashankar K, Sharma R, Gangawane A. Comparison of intubating conditions with rocuronium and vecuronium at specific times judged by clinical criteria. Neurosci Res 2010:9–25.
14
Uvelin A, Šunjkić A. HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2012;(3):194–6.
15
Reynolds S, Heffner J. Airway management of the critically ill patient -rapid intubation. Chest 2005:1397–412.
16
Jensen M, Chen C, Brugger A. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 2003:407–14.
17
Kwon M, Song J, Kim J. Tracheal intubation with rocuronium using a "modified timing principle. Korean J Anesthesiol 2013;(3):218–22.
18
Cooper R, Mirakhur R, Clarke R, Boules Z. Comparison of intubating conditions after administration of Org 9426 (Rocuronium) and Suxamethonium. Brit J 1992:269–73.
19
Apfelbaum J, Hagberg C, Caplan R, Blitt C, Connis R, Nickinovich D, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology 2013:251–70.
20
ASA physical status classification system 2014.
21
Misra M, Agarwal M, Pandey R, Gupta A. A comparative study of rocuronium, vecuronium and succinylcholine for rapid sequence induction of anaesthesia. Indian J Anaest 2005:469–73.
22
Motamed C, Donati F. Intubating conditions and blockade after mivacurium, rocuronium and their combination in young and elderly adults. Can J Anesth 2000:225–31.
23
Mathew A, Sharma A, Ganapathi P, Shankaranarayana P, Nazim M, Aiyappa D. Intraoperative hemodynamics with vecuronium bromide and rocuronium for maintenance under general anesthesia. Anesth Essays Res 2016:59–64.
24
Culling R, Middaugh R, Menk E. Rapid tracheal intubation with vecuronium: the timing principle. J Clini Anesth 1989:422–5.
25
Patil V, Chaudhari D. Shelgaonkar VA comparative study of rocuronium & suxamethonium for tracheal intubation during elective surgical procedures. Int J Biol Med Res 2014:4175–9.
26
Tran D, Newton E, Mount V, Lee J, Wells G, Perry J. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev 2015.
27
Ross W, Ellard L. Rapid Sequence Induction. Anesthesia Tutorial Of The Week. Tutorial 2016.
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