Comparison of intubating conditions after rapacuronium (Org 9487) and succinylcholine following rapid sequence induction in adult patients

We have assessed intubating conditions provided by rapacuronium (Org 9487) and succinylcholine after rapid sequence induction of anaesthesia in adult patients undergoing elective surgery. We studied 335 patients, ASA I and II , in five centres. Two hundred and thirty-four subjects with normal body we ight and 101 obese subjects were allocated randomly to one of four treatmen t groups differing in the neuromuscular blocking drug administered (rapacur onium 1.5 mg kg(-1) or succinylcholine mg kg(-1)) and in the technique used for induction of anaesthesia (fentanyl 2-3 mu g kg(-1) with thiopental 3-6 mg kg(-1) or alfentanil 20 mu g kg(-1) with propofol 1.5-2 mg kg(-1)). Int ubation was started at 50 s by an anaesthetist blinded to the drugs used. I ntubating conditions were clinically acceptable (excellent or good) in 89.4 % of patients after rapacuronium and in 97.4% after succinylcholine (P = 0. 004), the estimated difference being 8.1% (95% confidence interval (CI) 2.0 -14.1%). Neither anaesthetic technique nor subject group had an influence o n intubating conditions. After intubation, the maximum increase in heart ra te averaged 23.1 (SD 25.4)% and 9.4 (26.1)% after rapacuronium and succinyl choline, respectively (P < 0.001). Pulmonary side effects (bronchospasm and increased airway pressure) were observed in 10.7% (95% CI 5.8-17%) and 4.1 % (95% CI 1.3-8.8%) of patients given rapacuronium and succinylcholine, res pectively (P = 0.021). We conclude that after rapid sequence induction of a naesthesia in adults, clinically acceptable intubating conditions were achi eved less frequently after rapacuronium 1.5 mg kg(-1) than after succinylch oline.