Comparative Study of Efficacy and Safety of Rocuronium Bromide with Suxamethonium Chloride for Tracheal Intubation

Authors

  • Asawari Wagh Department Anaesthesia, Rajiv Gandhi medical college and Chhatrapati Shivajimaharaj hospital (RGMC), Kalwa, Thane, India
  • Anuradha Karande Department Anaesthesia, Ashwini Rural Medical College, Hospital and Research Centre, Kumbhari, Solapur, India
  • Sangita Page Department Anaesthesia, Ashwini Rural Medical College, Hospital and Research Centre, Kumbhari, Solapur, India
  • Vaishali Dabade Department Anaesthesia, Ashwini Rural Medical College, Hospital and Research Centre, Kumbhari, Solapur, India

DOI:

https://doi.org/10.55489/njmr.150220251069

Keywords:

Rocuronium Bromide, Suxamethonium Chloride, Tracheal Intubation, Neuromuscular Blocking Agents, Hemodynamic Stability, Postoperative Myalgia

Abstract

Background: Tracheal intubation is a cornerstone of modern anesthetic practice, with neuromuscular blocking agents playing a critical role. Among these agents, Suxamethonium chloride is widely used for its quick onset and brief duration. However, its associated side effects have prompted the search for alternatives like Rocuronium Bromide, a non-depolarizing agent known for its rapid onset, intermediate duration, and minimal adverse effects. The study aims to compare the effectiveness and safety of Suxamethonium chloride and Rocuronium Bromide. It evaluates their onset times, intubating conditions, duration of action, hemodynamic effects, and adverse reactions.

Materials and Methods: A randomized trial was conducted with 110 patients divided into two groups. Group A received Suxamethonium (1.5 mg/kg IV), and Group B was administered Rocuronium (0.9 mg/kg IV). Observations were made on intubation quality, onset timing, and hemodynamic changes.

Results: Group A exhibited faster onset and superior intubating conditions (100% excellent scores) compared to Group B (87.3% excellent scores). However, Rocuronium demonstrated longer duration of action, hemodynamic stability, with significantly lower postoperative heart rate and blood pressure fluctuations. Additionally, Group B had no reported adverse effects, while Group A experienced 12.7% postoperative myalgia.

Conclusion: Rocuronium represents a safer alternative for tracheal intubation, with enhanced hemodynamic stability and fewer side effects, despite slightly less favorable intubating conditions than Suxamethonium.

References

Utting JE. Et al. The era of relaxant anaesthesia. British Journal of Anesthesia 1992 Dec;69(6):551-3. DOI: https://doi.org/10.1093/bja/69.6.551 PMid:1467094 DOI: https://doi.org/10.1093/bja/69.6.551

Agoston S:Interactions of volatile anesthetics with Rocuronium bromide in perspective. European Journal of Anaesthesia.1994;11(9):107-111.

Cooper R., Mirakhur R.K.,ClarkeR.S.J.:Comparison of intubating conditions after administration of Org9426 and Suxamethonium ;British Journal of Anesthesia (1992); 69: 269-273. DOI: https://doi.org/10.1093/bja/69.3.269 PMid:1389845 DOI: https://doi.org/10.1093/bja/69.3.269

AndrewsJ.I., Kumar N. OlkkalaK.T.: A large sample randomized trial of Rocuronium Vs.Succinylcholine in rapid sequence induction of anesthesia along with propofol, Acta Anaesthesiologica Scandinavica (1999);43:4-8. DOI: https://doi.org/10.1034/j.1399-6576.1999.430102.x PMid:9926179 DOI: https://doi.org/10.1034/j.1399-6576.1999.430102.x

Atkinson R.S., RushmanG.B. Lee'ssynopsis of Anaesthesia. 11th Ed. 1993. Bartkowski R.R.,Witkowski T.A., Azad S.S. Dose Response and Recovery of Org.9426 under Enflur ane Anaethesia. Anesthesiology 1990;73(3A):A902. DOI: https://doi.org/10.1097/00000542-199009001-00900

Bowman WC. RodgerI W., Houstman J Structure Action Relationship among some disacetomy Analogues of Pancuronium and Vecu-roniumin Anaesthetized Cat.Anesthesiology1988;69:57-62. DOI: https://doi.org/10.1097/00000542-198807000-00009 PMid:2898902

Alfred C,Pinchak P.E.: Emergency surgery and rapid sequence intubation Rocuronium Vs. Succinylcholine, Dept. of Anaesthesiology, Metro Health Medical Centre, Case Western Reserve University, Cleveland,OH 44109.

Alvarez - Gornej J. A., Estelles M.E.: Pharmacokinetics and pharmaco-dynamics of Rocuronium Bromide in adult patients; European Journal of Anaesthesiology (1994); 11: 53-56.

FuschBuder T, Sparr HJ, Ziegenfuss T. Thiopentone or Etomidate for rapid sequence induction with Rocuronium. Br J Anaesth1998 : 80; 504-06. DOI: https://doi.org/10.1093/bja/80.4.504 PMid:9640158 DOI: https://doi.org/10.1093/bja/80.4.504

Hemmerling T.M. et al. "Comparison of succinylcholine with two doses of rocuronium using a new method of monitoring neuromuscular block at the laryngeal muscle by surface laryngeal electromyogarphy". Br. J Anaesth, 2000 Aug; 85 (2): 251-255. DOI: https://doi.org/10.1093/bja/85.2.251 PMid:10992834

Bunburaphong P et al, "Intubating conditions after three different doses of rocuronium bromide" J.MedAssoc Thai, 2001, Jun; 84(Suppl 1) : S 244-50.

Bowman W C, Rodger I W, Houston J et al. Structure action relationships among some disacetoxy analogues of pancuronium and vecuronium in anaesthetized cat. Anesthesiology1988; 69: 57-62. DOI: https://doi.org/10.1097/00000542-198807000-00009 PMid:2898902 DOI: https://doi.org/10.1097/00000542-198807000-00009

Muir A W, Houston J, Green K L, Marshall R J et al. Effects of a new neuromuscular blocking agent (oro 9426) in anaesthized cats and pigs and in isolated neuromuscle preparations. Br J Anaes 1989; 63: 400-410. DOI: https://doi.org/10.1093/bja/63.4.400 PMid:2573387 DOI: https://doi.org/10.1093/bja/63.4.400

Bartkowski R R, Witkowski T A, Azad S Set al. Dose- response and recovery of org. 9426 under enflurane anaesthesia. Anesthesiology 1990; 73(3A) : A902. DOI: https://doi.org/10.1097/00000542-199009001-00900 DOI: https://doi.org/10.1097/00000542-199009001-00900

Ratan Singh N, Thangluai T, Laithangbam PKS, Hemjit Singh T, Chaoba Singh L, Shanti Devi RK. Comparison of intubating conditions of succinylcholine, vecuronium androcuronium in patients undergoing elective surgery ‐ a study. Journal of Medical Society2011;25(2):54‐8.

Bhandari R, Verma AP, Singh R, Agrawal M, Mitra S, Krishnan G. Clinical evaluation of intubating conditions using two different doses of rocuronium and its comparison with succinylcholine for rapid sequence induction. International Journal of Contemporary Medical Research 2018;5(2):B34-B39.

Weiss JH, Gratz I, Goldberg ME, Afshar M, Insinga F, Larijani G. Double-blind comparison of two doses of rocuronium and succinylcholine for rapid-sequence intubation. J ClinAnesth. 1997 Aug;9(5):379-82. DOI: https://doi.org/10.1016/S0952-8180(97)00065-2 PMid:9257203 DOI: https://doi.org/10.1016/S0952-8180(97)00065-2

Kulkarni K. R. et al, "Intubating conditions with succinylcholine versus rocuronium" J.AnaesthClinPharmacol, 2010; 26(3) : 323-328. DOI: https://doi.org/10.4103/0970-9185.74682 DOI: https://doi.org/10.4103/0970-9185.74682

Singh A, Bhatia PK, Dr.Tulsani KL. Comparison of onset time, duration of action and intubating conditions achieved with suxamethonium and rocuronium. IndianJ Anaesth 2004; 48 (2): 129-133.

Shukla et al, "Comparative evaluation of haemodyanamic effects and intubating conditions after the administration of ORG 9426(Rocuronium) and succinylcholine" Indian J. Anaesth, 2004; 48(6) : 476-479.

Hemmerling T.M. et al. "Comparison of succinylcholine with two doses of rocuronium using a new method of monitoring neuromuscular block at the laryngeal muscle by surface laryngeal electromyogarphy". Br. J Anaesth, 2000 Aug; 85 (2): 251-255. DOI: https://doi.org/10.1093/bja/85.2.251 PMid:10992834 DOI: https://doi.org/10.1093/bja/85.2.251

Verma RK. A comparative study of the intubating conditions and cardiovascular effects following succinyl- choline &Rocuronium in adult elective surgical patients. The Internet Journal of Anaesthesiology 2007; 14:1. DOI: https://doi.org/10.5580/1030 DOI: https://doi.org/10.5580/1030

IbemhalHeisnam et al A Comparative Study of Intubating Conditions and Cardiovascular Effects of Rocuronium and Succinylcholine in Rapid Sequence Induction and Intubation, JMSCR 2017 june; Vol 5:6

Downloads

Published

2025-04-01

How to Cite

Wagh, A., Karande, A., Page, S., & Dabade, V. (2025). Comparative Study of Efficacy and Safety of Rocuronium Bromide with Suxamethonium Chloride for Tracheal Intubation. National Journal of Medical Research, 15(02), 96–102. https://doi.org/10.55489/njmr.150220251069

Issue

Section

Original Research Articles