Choice of the muscle relaxant for rapid-sequence induction:

Effect of ephedrine on intubating conditions created by propofol and rocuronium: a meta-analysis

OBJECTIVE

To evaluate the effect of ephedrine on intubation conditions (ICs) one minute after anesthesia induction using propofol and rocuronium.

METHODS

PubMed, EMbase, The Cochrane Library, ISI Web of Knowledge, Chinese Biomedical Literature Database, Google Scholar, and other databases were searched from inception to September 2012 to collect relevant randomized clinical trials (RCTs). We evaluated the risk of bias of the included studies by the Cochrane Collaboration's risk of bias tool and analyzed the data using RevMan 5.1. As the outcomes, excellent ICs, clinically acceptable ICs and side effects were evaluated with risk ratios (RRs).

RESULTS

Five RCTs involving 396 patients were identified. The results of the meta-analysis demonstrated that ephedrine increased the rate of excellent ICs (RR = 2.40, 95% CI 1.89 to 3.05), but had no effects on the rate of clinically acceptable ICs (RR = 1.15, 95% CI 0.93 to 1.42) and the incidence of side effects (RR = 2.00, 95% CI 0.19 to 21.36). Besides, the results of subgroup analysis showed that both low dose and high dose of ephedrine increased the rate of excellent ICs, but only low dose increased the rate of clinically acceptable ICs. The results of sensitive analysis showed that both favored ephedrine (excellent ICs: RR = 2.54, 95% CI 1.69 to 3.83; clinically acceptable ICs: RR = 1.21, 95% CI 1.07 to 1.38).

CONCLUSION

Ephedrine, without extra side effects, created superior ICs one minute after anesthesia induction using propofol and rocuronium, and low dose (i.e., 70-100 μg/kg) is recommended as the possible optimal dose.

Comparative study of intubating conditions at the first minute with suxamethonium, rocuronium and different priming techniques of rocuronium

BACKGROUND AND OBJECTIVE

To evaluate orotracheal intubation conditions after 1 min.

PATIENTS AND METHODS

A prospective randomized study with 376 adult American Society of Anesthesiologists (ASA) Grade I-III patients. Each patient received propofol, fentanyl and either suxamethonium (1 mg kg(-1)) or rocuronium. The intubating dose of rocuronium (2 x ED95) was preceded 4 min earlier by saline, or a 0.1 x ED95 priming dose of rocuronium, atracurium, cis-atracurium, vecuronium or mivacurium. Intubating conditions were graded as excellent, good or poor with respect to laryngoscopy, vocal cord position and movement and reaction to intubation and/or cuff inflation.

RESULTS

There were significant differences (P < 0.05) in laryngoscopy between suxamethonium and rocuronium primed with saline, atracurium or cis-atracurium. With respect to vocal cord position and movement during intubation, rocuronium without priming differed significantly from all other groups and for reaction to insertion of tracheal tube and/or cuff inflation. Rocuronium without priming differed significantly from all other groups except for rocuronium primed with itself. The mivacurium group showed more signs of pre-curarization than other groups (P < 0.05). There were significant differences between rocuronium alone and the other groups when final intubating conditions were compared.

CONCLUSIONS

Priming rocuronium with 0.1 x ED95 of vecuronium, rocuronium, atracurium or cis-atracurium is a safe technique and did not increase risk of pre-curarization in healthy patients.