Rapid and safe intubation with rocuronium bromide in critically ill patients

Background

Critically ill patients need sometimes orotraqueal intubation and mechanical ventilation. A muscle relaxant with rapid onset time, producing good intubation conditions is required. Succinylcholine provides this goal, but it has several undesirable side effects. Rocuronium bromide is a new muscle relaxant with an onset time shorter than other because its low potency, allowing orotracheal intubation at 60–90 s, being free of cardiovascular and other side effects.

Objectives

The aim of this study is to assess in a prospective manner onset time, and intubation conditions at 60 s, and side effects after a dose of rocuronium bromide.

Methods

Patients aged 18–70 years admitted to the ICU who required mechanical ventilation, were included in this study. Neuromuscular disease was an exclusion criterian. After fentanyl 1 μg/kg and etomidate 0.2 mg/kg, patients received a bolus dose of 0.6 mg/kg of rocuronium bromide. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) were monitored before and after administration of bolus dose. Neuromuscular response was monitored with a peripheral nerve stimulator with two electrodes on the wrist. Train of four (TOF) was the mode chosen for stimulation and the number of responses at the thumb was recorded by tactile evaluation. Intubation conditions were assessed following previous published scores, in excellent, good, poor and impossible. Data are presented as mean values; statistical analysis was made by Wilcoxon test, considering P ≤ 0.05 as significance level.

Results

Eight patients, mean age 54.5 years, three man and five women, were included in the study, all of them requiring mechanical ventilation because respiratory failure. Onset time of bolus dose of rocuronium bromide was 3.2 min; maximal degree of blockade was 80% in one patient and 100% in the remaining; and clinical duration was 24.2 min. Intubation conditions were excellent in six patients and good two ones. There were not significant changes in HR, SAP, DAP and MAP after rocuronium regarding control values and no other types of side effects appeared.

Conclusions

Rocuronium bromide allows rapid and safe intubation under suitable conditions in critically ill patients, without haemodynamic changes.