Comparison of the intubation conditions provided by rapacuronium (ORG 9487) or succinylcholine in humans during anesthesia with fentanyl and propofol

Neal Fleming, Frances Chung, Peter S A Glass, John B. Kitts, Hans Kirkegaard-Neilsen, Gerald A. Gronert, Vincent Chan, Tong J. Gan, Nicholas Cicutti, James E. Caldwell

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Background: Currently, the only approved muscle relaxant with a rapid onset and short duration of action is succinylcholine, a drug with some undesirable effects. Rapacuronium is an investigational nondepolarizing relaxant that also has a rapid onset and short duration and consequently should be compared with succinylcholine in its ability to facilitate rapid tracheal intubation. Methods: This prospective, randomized clinical trial involved 336 patients. Anesthesia was induced with fentanyl and propofol and either 1.5 mg/kg rapacuronium or 1.0 mg/kg succinylcholine. The goal was to accomplish tracheal intubation by 60 s after administration of the neuromuscular blocking drug. Endotracheal intubation was performed, and conditions were graded by a blinded investigator. Recovery of neuromuscular function was assessed by electromyography. Results: Intubation conditions were evaluated in 236 patients. Intubation by 60 s after drug administration occurred in 100% of patients with rapacuronium and in 98% with succinylcholine. Intubation conditions were excellent or good in 87% of patients with rapacuronium and in 95% with succinylcholine (P < 0.05). The time (median and range) to the first recovery of the train-of-four response was 8.0 (2.8-20.0) min with rapacuronium and 5.7 (1.8-17.7) min with succinylcholine (P < 0.05). The overall incidence of adverse effects was similar with both drugs. Conclusions: A 1.5-mg/kg dose of rapacuronium effectively facilitates rapid tracheal intubation. It can be considered a valid alternative to 1.0 mg/kg succinylcholine for this purpose.

Original languageEnglish (US)
Pages (from-to)1311-1317
Number of pages7
JournalAnesthesiology
Volume91
Issue number5
DOIs
StatePublished - Nov 1999

Keywords

  • Adverse events
  • Cardiovascular
  • Neuromuscular block

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Fleming, N., Chung, F., Glass, P. S. A., Kitts, J. B., Kirkegaard-Neilsen, H., Gronert, G. A., Chan, V., Gan, T. J., Cicutti, N., & Caldwell, J. E. (1999). Comparison of the intubation conditions provided by rapacuronium (ORG 9487) or succinylcholine in humans during anesthesia with fentanyl and propofol. Anesthesiology, 91(5), 1311-1317. https://doi.org/10.1097/00000542-199911000-00023