Rapacuronium 2.0 or 2.5 mg kg–1 for rapid‐sequence induction: comparison with succinylcholine 1.0 mg kg–1

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The purpose of this nine‐centre study in 602 patients was to show that the frequency of acceptable intubating conditions after rapacuronium 2.0 or 2.5 mg kg–1 is not more than 10% lower than the frequency after succinylcholine 1.0 mg kg–1 during rapid‐sequence induction of anaesthesia with fentanyl 1–2 µg kg–1 and thiopental 2–7 mg kg–1. Laryngoscopy and intubation were carried out 60 s after administration of muscle relaxant by an anaesthetist blinded to its identity. Intubating conditions were clinically acceptable (excellent or good) in 91.8% of patients given succinylcholine and in 84.1 and 87.6% of patients given rapacuronium 2.0 and 2.5 mg kg–1 respectively. With respect to the percentage of clinically acceptable intubating conditions, the estimated difference (and the upper limit of the one‐sided 97.5% confidence interval) between succinylcholine and rapacuronium 2.0 mg kg–1 was 7.8 (14.4)% and between succinylcholine and rapacuronium 2.5 mg kg–1 it was 4.0 (10.2)%. For both comparisons, the upper limit of the one‐sided confidence interval exceeded the predefined 10% difference. Hence, it could not be demonstrated that the intubating conditions with either of the two doses of rapacuronium were not inferior to those with succinylcholine 1.0 mg kg–1. The increase in heart rate was significantly greater during the first 5 min in the rapacuronium groups, but the arterial pressure increased significantly only in the succinylcholine group (P<0.001). Respiratory side‐effects were observed in 4.0, 13.5 and 18.5% of patients after succinylcholine and rapacuronium 2.0 and 2.5 mg kg–1 respectively (P<0.05). As the non‐inferiority of intubating conditions after rapacuronium 2.0 and 2.5 mg kg–1 could not be proven, succinylcholine should be considered the neuromuscular blocking agent that provides better intubating conditions for rapid‐sequence induction. Br J Anaesth 2000; 85: 724–31

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