INFLUENCE OF INDUCTION TECHNIQUE ON INTUBATING CONDITIONS AFTER ROCURONIUM IN ADULTS - COMPARISON WITH RAPID-SEQUENCE INDUCTION USING THIOPENTONE AND SUXAMETHONIUM

We have assessed the effect of anaesthetic technique on intubating con ditions after rocuronium 0.6 mg kg(-1) in four groups (n = 25 each) of unpremedicated patients in whom anaesthesia was induced with either t hiopentone 5 mg kg(-1) or propofol 2.5 mg kg(-1) alone, or supplemente d with alfentanil 20 mu g kg(-1). Fifty control patients were anaesthe tized with thiopentone followed by suxamethonium. Laryngoscopy was com menced at 45 s. Overall intubating conditions after rocuronium were si milar to those after suxamethonium (good and excellent greater than or equal to 96%) only when alfentanil was part of the induction regimen. However, intubation time was similar in all five groups and averaged 55 (SD 3.2) s, and the tube could be passed through open vocal cords w ithin 70 s. After rocuronium the response of the diaphragm to intubati on was more pronounced in the two groups of patients not receiving alf entanil (P < 0.0001) and in patients anaesthetized using propofol with alfentanil (P < 0.01) than in the control group. Opioids (in doses eq uivalent to alfentanil 20 mu g kg(-1)) constitute an integral part of an induction regimen containing rocuronium 0.6 mg kg(-1), regardless o f whether or not thiopentone or propofol is used, in order to achieve overall intubating conditions similar to those after suxamethonium.