The effect of rocuronium priming dose based on actual versus corrected body weight in modified rapid sequence intubation

Background

Rapid sequence intubation (RSI) is a technique that allows patients to be quickly intubated and have the airway secured.

Aims

The purpose of this study was to investigate the effect of rocuronium priming and intubation dose calculated according to actual body weight (ABW) or corrected body weight (CBW) on the neuromuscular block and intubation quality in rapid sequence induction and intubation (RSII).

Patients and Methods

This prospective randomized, double-blind study was conducted on a total of 60 patients randomized into two groups using the closed-envelope method between January 2021 and December 2021, with 30 individuals in each group. In group 1, CBW was used with the formula to calculate the neuromuscular blocking drug (NMBD) dose. The ABW of patients was used to calculate the NMBD dose in group 2.

Results

The data of 50 female patients who underwent group 1 (CBW, n = 25) and group 2 (ABW, n = 25) were analyzed. Age, weight, height, body mass index (BMI), quality of laryngoscopy, post-priming side effects, mean arterial pressure (MAP), and heart rate (HR) values did not differ across the groups. When train-of-four (TOF) values, priming and intubation dose, and laryngoscopy time were compared, a statistically significant difference was found between the two groups of TOF count (TOF C) 1 (the duration of action).

Conclusion

This study suggests that the application of rocuronium priming and intubation dose according to CBW in RSII, especially during the pandemic, provided similar intubation conditions as the application according to ABW, while its shorter duration of action shows that it can be preferred, especially in short-term surgical cases.

A case of sciatic neuropathy after caesarean section under spinal anaesthesia

We present a rare case in which a healthy parturient developed a left sciatic neuropathy after spinal anaesthesia for caesarean section. Intraoperatively, a wedge was placed under her right buttock to tilt the pelvis and uterus to the left, to minimise aortocaval compression. Postoperatively, she complained of being unable to move her left foot. Neurologic examination revealed a left lower leg paresis. Electromyography showed denervation potentials on muscles innervated by left sciatic nerve. Seven weeks after surgery the patient had made a full recovery. We conclude that the prolonged lateral tilt position might cause compression neuropathy of the sciatic nerve. After childbirth, re-positioning the patient supine or shortening the time of lateral tilt may reduce the risk of sciatic nerve injury.