Dose of rocuronium for rapid tracheal intubation following remifentanil 2 [mu]g kg-1 and propofol 2 mg kg-1.
Oh, Ah-Young; Cho, Suk-Ju; Seo, Kwang-Suk; Ryu, Jung-Hee; Han, Sung-Hee; Hwang, Jung-Won
[Miscellaneous Article]
European Journal of Anaesthesiology.
30(9):550-555, September 2013.
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CONTEXT: Full relaxation is not mandatory for successful tracheal intubation.
OBJECTIVE: We tried to find the dose of rocuronium that gave acceptable intubation conditions in a rapid sequence intubation with remifentanil and propofol.
DESIGN: A dose-finding study of rocuronium using a modified Dixon's up-and-down method.
SETTING: A single tertiary care teaching hospital.
PARTICIPANTS: Patients undergoing elective surgery under general anaesthesia.
INTERVENTIONS: After premedication with midazolam and glycopyrrolate, anaesthesia was induced using remifentanil 2 [mu]g kg-1 and propofol 2 mg kg-1, and a predetermined dose of rocuronium was administered. The dose of rocuronium was determined by a modified Dixon's up-and-down method starting from 0.8 mg kg-1 with an interval of 0.1 or 0.05 mg kg-1. Intubation was performed 60 s after the start of the rocuronium injection. Intubation conditions were graded as excellent, good or poor. Excellent or good were regarded as clinically acceptable.
MAIN OUTCOME MEASURE: A dose of rocuronium needed for acceptable intubation condition in 50% of patients (ED50) during rapid tracheal intubation after induction of anaesthesia with remifentanil and propofol.
RESULTS: Twenty-eight patients were enrolled to obtain six crossovers. The ED50 of rocuronium was 0.20 mg kg-1 (95% confidence interval, CI 0.17 to 0.23 mg kg-1) by a modified Dixon's up-and-down method.
CONCLUSION: After induction of anaesthesia with remifentanil 2 [mu]g kg-1 and propofol 2 mg kg-1, the ED50 of rocuronium for acceptable intubation condition was 0.20 mg kg-1 (95% CI, 0.17 to 0.23 mg kg-1) for rapid sequence intubation. Thus, we recommend that the intubation dose should be 0.8 mg kg-1.
TRIAL REGISTRATION: Clinical trial registration KCT0000094.
(C) 2013 European Society of Anaesthesiology