A Comparative study to find an Ideal Intubating Dose of inj. Rocuronium Bromide using inj. Vecuronium Bromide as control

Abstract

INTRODUCTION: Endotracheal intubation is an integral part of administration of anaesthesia during surgical procedure. Succinylcholine, a depolarizing muscle relaxant with rapid onset of action and short duration is still the relaxant of choice to facilitate tracheal intubation. But in addition to fasciculations, succinylcholine has many side effects such as bradycardia, dysrhythmias, increased release of potassium, postop myalgia, increased intra ocular pressure, intra cranial tension, intra gastric pressure, prolonged recovery in patients with pseudocholinesterase deficiency, masseter spasm and triggering malignant hyperthermia. Since these side effects are due to depolarizing mechanism of action of Succinylcholine, search has been focused on to find an ideal non depolarizing muscle relaxant with rapid onset time and offering excellent intubating conditions and also lacking all the above mentioned side effects. AIM OF THE STUDY: The aim of the present study is to find an ideal intubating dose of Inj. Rocuronium bromide 0.6mg/kg (2 ED 95) and 0.9mg/kg (3 ED 95) comparing with Inj. Vecuronium bromide 0.1mg /kg (2 ED 95) as control with regards to • Intubating conditions. • Onset of blockade or time to maximum blockade. • Duration of blockade. • Hemodynamic stability. MATERIALS AND METHODOLOGY: Adult patients of both sexes in the age group of 15-50 yrs belonging to ASA I / II category and their weight ranging 40-80 kg posted for various surgeries requiring general anaesthesia at Department of General Surgery, Department of Surgical Gastroenterology, Department of Plastic Surgery, Department of Urology and Department of Eye, Nose and Throat, Govt. KMCH, formed the study group. This study was designed as randomized, prospective study. The study was performed after obtaining the institutional ethical committee approval. Pre study assessment was done, procedure explained and informed consent obtained and patients were randomly allocated into 3 groups requiring GA. Groups : 1. Group I :15 patients receiving Inj. Rocuronium Bromide 0.6 mg/kg 2. Group II :15 patients receiving Inj. Rocuronium Bromide 0.9 mg/kg 3. Group III :15 patients receiving Inj. Vecuronium bromide 0.1 mg/kg Patient Selection : Inclusion Criteria : 1. 45 patients of ASA grade I & II 2. Age 15-50 yrs 3. Both sex 4. Requiring General Anaesthesia with Endotracheal Intubation. 5. Elective Surgery 6. Without any comorbid illness. Exclusion criteria: 1. Having any allergy to narcotics or neuromuscular blocking drug, 2. Patients on any other treatment which might interfere with action of NM blocking drugs, 3. Pregnant patients, 4. Having neuro muscular diseases, 5. Having preop airway or intubation problems. Drug Treatment: 1. Group A : ROC 0.6 mg /kg, 2. Group B: ROC 0.9 mg /kg, 3. Group C: VEC 0.1 mg/kg. Monitoring: 1. Pulse oximetry, 2. NIBP, 3. ECG, 4. TOF-WATCH SX 100, 5. Temperature Monitor. TOF WATCH SX: 1. Has two optional calibration modes. 2. Acceleration transducer, temperature sensor and cable for surface electrodes present. 3. Nerve stimulation attained at low current 4. Display of data in computers. 5. Train of four with programmable repetition time. Methodology: 1. 45 patients were randomized into three groups of 15 each. 2. Premedication : Patients premedicated with Inj. Glycopyrrolate 0.2 mg IV, Inj. Fentanyl 2 mcg/kg IV 15 min before induction. 3. Preoxygenation : Done with 100% O2 for 3 min. SUMMARY: 1. Group II patients receiving Inj.Roc 0.9 mg/kg showed excellent intubating conditions between 60 – 90 sec. 2. Group I patients receiving Inj.Roc 0.6 mg/kg had maximum blockade between 150–180 sec and Group III patients receiving Inj.Vec 0.1 mg/kg had maximum blockade between 180-210 sec. 3. The mean duration of action in Group II (Inj.Roc 0.9) was 48 min. 4. The mean duration of action in Group I (Inj.Roc 0.6) was 37 min and in Group III (Inj.Vec 0.1) was 39 min. 5. There were no significant changes in hemodynamic variables in all three groups. CONCLUSION: In conclusion, Roc 0.9 mg/kg provides excellent intubating conditions with rapid onset of action, with longer duration of action and no significant hemodynamic changes when compared with Roc 0.6 mg/kg and Vec 0.1mg/kg and hence can be used as an ideal intubating dose. From the above mentioned study it can also be concluded that Roc 0.9mg/kg can be used for rapid sequence intubation in the place of depolarizing muscle relaxants like succinylcholine