A Comparative study among atracurium vecuronium and recuronium as pretreatment in preventing succinylcholine-induced fasciculations.
A Comparative study among atracurium vecuronium and recuronium as pretreatment in preventing succinylcholine-induced fasciculations.
- Fairview, Quezon City: Department of Anesthesiology, FEU-NRMF 2006.
- tables; (in folder)
Includes appendices and bibliographical references.
Abstract: Succinylcholine is still widely used to facilitate tracheal intubation, because of its short onset of action and rapid recovery. It is especially recommended when clinical conditions require emergency airway protection during a rapid sequence induction of anesthesia and for patients with anticipated difficult airways/intubation. However, administration of succinylcholine has many side effects, including fasciculations and post operative muscle pain. Succinylcholine-induced fasciculations have a pre-synaptic origin and generally a small dose of non-depolarizing muscle relaxant (pretreatment) is effective in reducing their incidence. Atracurium is one of the most popular non-depolarising muscle relaxants used for pretreatment. Vecuronium is a non-depolarizing muscle relaxant also used for pretreatment which is devoid of significant cardiovascular effects. Rocuronium is a novel non-depolarizing muscle relaxant that has a promising potential as a pretreatment drug because of its short onset of action. The objective of this trial is to compare the efficacy of Atracurium, Vecuronium and Rocuronium as pretreatment in preventing succinylcholin-induced fasciculations. Sixty ASA I and II patients scheduled for elective survey under general anesthesia were enrolled in this double blind study. They were randomly divided into 3 groups 20 according to the non-depolarizing pretreatment drug to be used: (1) 0.05 mg/kg Atracurium, (2) 0.01 mg/kg Vecuronium, and (3) 0.06 mg/kg Rocuronium. Three minutes after pretreatment, succinylcholine at 1.5 mg/kg was administered. The incidence and intensity of fasciculations, the ease of tracheal intubation, and the severity of post operative myalgia were assessed. There was no difference among the three groups with respect to age, sex distribution and weight. Fasciculations occurred in 25 (41%) out of 60 patients: 4 (20%) in the rocuronium group, 10 (50%) in the atracurium group and 11 (55%) in the vecuronium group, P>0.05. The severity of fasciculations was lowest in the rocuronium group, followed by the atracurium group and highest in the vecuronium group. Intubating conditions were rated as excellent, good, fair or poor in all patients. There was no significant difference among groups. Post operative myalgia occurred in 7 (12%) out of 60 patients: none in rocuronium group, 3 (15%) in the vecuronium group and 4 (20%) in the atracurium group. The severity of post operative myalgia is higher in the vecuronium group with a 5% incidence of moderate pain. Howeve, no significant difference among groups was determined. In summary, this study demonstrates that rocuronium is superior to atracuriumand vecuronium as pretreatment in preventing succinylcholine-induced fasciculations and post operative myalgia.
Research - Department of Anesthesiology
ANES 2006 0001
Includes appendices and bibliographical references.
Abstract: Succinylcholine is still widely used to facilitate tracheal intubation, because of its short onset of action and rapid recovery. It is especially recommended when clinical conditions require emergency airway protection during a rapid sequence induction of anesthesia and for patients with anticipated difficult airways/intubation. However, administration of succinylcholine has many side effects, including fasciculations and post operative muscle pain. Succinylcholine-induced fasciculations have a pre-synaptic origin and generally a small dose of non-depolarizing muscle relaxant (pretreatment) is effective in reducing their incidence. Atracurium is one of the most popular non-depolarising muscle relaxants used for pretreatment. Vecuronium is a non-depolarizing muscle relaxant also used for pretreatment which is devoid of significant cardiovascular effects. Rocuronium is a novel non-depolarizing muscle relaxant that has a promising potential as a pretreatment drug because of its short onset of action. The objective of this trial is to compare the efficacy of Atracurium, Vecuronium and Rocuronium as pretreatment in preventing succinylcholin-induced fasciculations. Sixty ASA I and II patients scheduled for elective survey under general anesthesia were enrolled in this double blind study. They were randomly divided into 3 groups 20 according to the non-depolarizing pretreatment drug to be used: (1) 0.05 mg/kg Atracurium, (2) 0.01 mg/kg Vecuronium, and (3) 0.06 mg/kg Rocuronium. Three minutes after pretreatment, succinylcholine at 1.5 mg/kg was administered. The incidence and intensity of fasciculations, the ease of tracheal intubation, and the severity of post operative myalgia were assessed. There was no difference among the three groups with respect to age, sex distribution and weight. Fasciculations occurred in 25 (41%) out of 60 patients: 4 (20%) in the rocuronium group, 10 (50%) in the atracurium group and 11 (55%) in the vecuronium group, P>0.05. The severity of fasciculations was lowest in the rocuronium group, followed by the atracurium group and highest in the vecuronium group. Intubating conditions were rated as excellent, good, fair or poor in all patients. There was no significant difference among groups. Post operative myalgia occurred in 7 (12%) out of 60 patients: none in rocuronium group, 3 (15%) in the vecuronium group and 4 (20%) in the atracurium group. The severity of post operative myalgia is higher in the vecuronium group with a 5% incidence of moderate pain. Howeve, no significant difference among groups was determined. In summary, this study demonstrates that rocuronium is superior to atracuriumand vecuronium as pretreatment in preventing succinylcholine-induced fasciculations and post operative myalgia.
Research - Department of Anesthesiology
ANES 2006 0001
