AIMS & OBJECTIVE:
The aim of this prospective, Randomized study is to demonstrate that Rocuronium bromide in dose of 1mg/kg can be used for induction in comparison with succinylcholine 1mg/kg. According to Modified vibymogenson grading system for intubation and nerve stimulator; intubating conditions with both the drugs are compared and adverse effects.
MATERIALS AND METHOD:
After obtaining individual informed consent and approval from the Ethical Committee 100 patients under ASA I and II, in the age group of 18-65 yrs., who are undergoing elective abdominal surgery under general anaesthesia were included in this prospective, randomised controlled study.
• GROUP A- 50 patients received Rocuronium Bromide 1mg/kg.
• GROUP B- 50 patients received Suxamethonium 1mg/kg.
METHOD:
Anaesthetic management were standardized in all patients. Premedication was given to all patients. An 18 G catheter was inserted in a forearm vein for fluid and drug administration. Monitoring
with non-invasive blood pressure (NIBP), ECG, saturation of oxygen (SpO2), end-tidal CO2 were instituted during the procedure.
After 3 min of Preoxygenation, patient was induced with Inj.glycopyrollate 0.2mg and Inj.fentanyl 2 ug/kg and propofol 1.5 mg/kg. The neuromuscular blocking drug was injected as soon as the
phonation reflex had disappeared, and the nerve stimulator was switched to the single-twitch mode (rate, one twitch per second). Laryngoscopy was started after the cessation of a visible motor response to continuous single twitch nerve stimulation, time for the disappearance of twitch response was noted. Endotracheal intubations were performed using a Macintosh size 3 blade and a tracheal tube with an internal diameter of 7.5 cm in women and of 8.5 cm in men. The timing of events were noted accurately.
PARAMETERS TO BE MONITORED:
The following parameters are assessed:
Primary outcome measures were:
Intubation conditions are usually evaluated using the following factors:
(a) Ease of laryngoscopy,
(b) Position and movement of the vocal cords, and
(c) Response to intubation of the airway and the limbs.
Ratings are based on Modified viby-mogenson scoring system (criteria’s use to attribute scores in evaluating intubating conditions are jaw relaxation, vocal cord position and diaphragmatic activity) proposed for good clinical research practice in studies of neuromuscular blocking drugs.
The intubating anaesthesiologist will rate the ease of laryngoscopy, the movement and position of the vocal cords, and the reaction to intubation.
Secondary outcome measures included
1. Side Effects like Hyperkalaemia, Dysrhythmia, and myalgia,
2. Patient satisfaction score.
RESULTS:
All demographic parameters are compared in both the groups, and they are found to be stastically insignificant so there is equal distribution of patients according to age, sex, height, weight.
On comparison time required for the disappearance of response to Single twitch stimuli it is found that Group A i.e. succinylcholine group requires less time than group B i.e. Rocuronium group and the time difference is statistically significant.
On analysing the intubating condition according to the grading system there are more number of patients having better intubating conditions in both the group, while comparing both the group it’s
better for succinylcholine chloride then Rocuronium but overall it is statistically insignificant.
CONCLUSION:
We conclude from our study that the intubating conditions after Rocuronium bromide 1mg/kg are almost similar and clinically acceptable intubating conditions as those obtained by succinylcholine 1mg/kg with a lower incidence of side effects when compared with succinylcholine.
On comparing the changes in potassium ion concentration there is statistically significant rise in potassium ion concentration in succinylcholine group after drug administration while there is almost no change in the Rocuronium group after drug administration. There is also significant change after drug administration on comparing both the groups. On comparing Myalgia there are more number of cases in Group A having Myalgia when comparing with Group B. On comparing dysrhythmias there are more number of cases in Group A having rhythm changes on comparing with Group B but not statistically significant
