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Comparison of Intubating Conditions in Patients Induced with Succinylcholine, Atracurium and Priming with Atracurium


Affiliations
1 Associate Professor, Department of Anaesthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, India
2 Former PG Resident, Department of Anaesthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, India
 

Background: This was a comparative observational study to compare the intubating conditions in patients posted for elective surgeries under general anaesthesia using succinylcholine, atracurium or priming with atracurium. Depolarizing muscle relaxant, frequently used for rapid sequence endotracheal intubation, has serious complications that occur intermittently, such as, hyperkalemia, increased intraoccular pressure and sudden cardiac arrest. So the priming principle, i.e., the administration of a subparalyzing dose of a nondepolarizing muscle relaxant (priming dose) prior to the intubating dose, was developed for rapid sequence endotracheal intubation with nondepolarizing muscle relaxant. This study compares the intubating conditions using a depolarizing muscle relaxant, a nondepolarizing muscle relaxant and priming with a nondepolarizing muscle relaxant. Methodology: Total 114 patients scheduled for elective surgeries were allocated into 3 groups. We assessed the intubating conditions with jaw relaxation, position of vocal cords, response to intubation (coughing, straining or muscular movements), haemodynamic response to intubation and number and strength of twitches to train of four stimuli just before intubation. Results: All the patients in different study groups were comparable in terms of age, sex, ASA status. The mean SBP, DBP was statistically significantly higher in Group B as compared to Group C group and Group A from 1 minute after intubation till after extubation. Good jaw relaxation was most commonly observed in group A (100%) as compared to group C (31%) and group B (17.5%) and the difference was statistically significant. Open vocal cord was most commonly observed in group A (100%) as compared to group C (75%) and group B (23%) and the difference was statistically significant. Severe coughing was most commonly observed in group B (17.5%) as compared to group C (0%) and group A (0%) and the difference was statistically significant. Severe muscular movements was most commonly observed in group B (21%) as compared to group C (0%) and group A (0%) and the difference was statistically significant.1,2,3 twitch was most commonly observed in group B (100%) as compared to group C (77.5%) and group A (56%) and the difference was statistically significant. Increase in BP and pulse > 20% of basal values was most commonly observed in group B (42%) as compared to group C (0%) and group A (0%) and the difference was statistically significant. Excellent to good scoring was most commonly observed in group A (100%) as compared to group C (92.5%) and group B (25%) and the difference was statistically significant. Conclusion: Succinylcholine is still the ideal choice for rapid sequence induction. Priming with atracurium can be used as an efficient alternative when succinylcholine is contraindicated.

Keywords

Succinylcholine, Atracurium, Intubation, Muscle Relaxant, Elective Surgery
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  • Comparison of Intubating Conditions in Patients Induced with Succinylcholine, Atracurium and Priming with Atracurium

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Authors

Sarita Phulkar
Associate Professor, Department of Anaesthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, India
Ravisha Yatish Parikh
Former PG Resident, Department of Anaesthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, India
Hemant Pawar
Associate Professor, Department of Anaesthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, India

Abstract


Background: This was a comparative observational study to compare the intubating conditions in patients posted for elective surgeries under general anaesthesia using succinylcholine, atracurium or priming with atracurium. Depolarizing muscle relaxant, frequently used for rapid sequence endotracheal intubation, has serious complications that occur intermittently, such as, hyperkalemia, increased intraoccular pressure and sudden cardiac arrest. So the priming principle, i.e., the administration of a subparalyzing dose of a nondepolarizing muscle relaxant (priming dose) prior to the intubating dose, was developed for rapid sequence endotracheal intubation with nondepolarizing muscle relaxant. This study compares the intubating conditions using a depolarizing muscle relaxant, a nondepolarizing muscle relaxant and priming with a nondepolarizing muscle relaxant. Methodology: Total 114 patients scheduled for elective surgeries were allocated into 3 groups. We assessed the intubating conditions with jaw relaxation, position of vocal cords, response to intubation (coughing, straining or muscular movements), haemodynamic response to intubation and number and strength of twitches to train of four stimuli just before intubation. Results: All the patients in different study groups were comparable in terms of age, sex, ASA status. The mean SBP, DBP was statistically significantly higher in Group B as compared to Group C group and Group A from 1 minute after intubation till after extubation. Good jaw relaxation was most commonly observed in group A (100%) as compared to group C (31%) and group B (17.5%) and the difference was statistically significant. Open vocal cord was most commonly observed in group A (100%) as compared to group C (75%) and group B (23%) and the difference was statistically significant. Severe coughing was most commonly observed in group B (17.5%) as compared to group C (0%) and group A (0%) and the difference was statistically significant. Severe muscular movements was most commonly observed in group B (21%) as compared to group C (0%) and group A (0%) and the difference was statistically significant.1,2,3 twitch was most commonly observed in group B (100%) as compared to group C (77.5%) and group A (56%) and the difference was statistically significant. Increase in BP and pulse > 20% of basal values was most commonly observed in group B (42%) as compared to group C (0%) and group A (0%) and the difference was statistically significant. Excellent to good scoring was most commonly observed in group A (100%) as compared to group C (92.5%) and group B (25%) and the difference was statistically significant. Conclusion: Succinylcholine is still the ideal choice for rapid sequence induction. Priming with atracurium can be used as an efficient alternative when succinylcholine is contraindicated.

Keywords


Succinylcholine, Atracurium, Intubation, Muscle Relaxant, Elective Surgery

References