A large simple randomized trial of rocuronium versus succinylcholine in rapid-sequence induction of anaesthesia along with propofol

Background: Rocuronium has an onset of action more rapid than other non-dep olarizing neuromuscular blocking agents, but it is unclear whether it and s uccinylcholine give equivalent intubating conditions during rapid-sequence induction of anaesthesia. We performed this study to answer the question - are there clinically relevant differences between the use of rocuronium and succinylcholine to secure acceptable intubating conditions during rapid-se quence induction of anaesthesia with propofol? Methods: Anaesthesia was induced using propofol 2.5 mg/kg in 349 ASA physic al status grade I-IV patients who were undergoing either elective or emerge ncy surgery. Propofol was followed immediately by either rocuronium 0.6 or 1 mg/kg or succinylcholine 1.0 mg/kg (randomly selected). Fifty seconds aft er the end of muscle relaxant injection laryngoscopy was performed and intu bating conditions were graded by an experienced anaesthetist blind to the m uscle relaxant allocation. This study design was selected so that a 10% dif ference in clinically acceptable intubating conditions between drugs would be detectable. Results: In this setting rocuronium 1.0 mg/kg provided superior intubating conditions compared with rocuronium 0.6 mg/kg. The incidence of clinically acceptable intubating conditions with rocuronium 1.0 mg/kg and succinylchol ine 1.0 mg/kg was 93.2% and 97.1% respectively, the difference being -3.9% (95% C.I. -9.7% to 1.9%). Conclusion: Rocuronium 1.0 mg/kg given along with propofol in a rapid-seque nce induction of anaesthesia is clinically equivalent to succinylcholine 1. 0 mg/kg.