Pakeeza Khanum,
Ubaidullah Bhat,
Beenish Mehraj,
- Lecturer, Department of Anaesthesiology, Ibn-Sina College, Ompura, Budgam, Jammu & Kashmir, India
- M.V.Sc., Department of Animal Genetics & Breeding, ICAR, National Dairy Research Institute, Karnal, Haryana, India
- Senior Resident, Department of Anaesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu & Kashmir, India
Abstract
Background: Rapid Sequence Intubation (RSI) is an airway management procedure designed to quickly secure the airway while reducing the likelihood of gastric aspiration during anesthesia induction. For many years, Succinylcholine has been regarded as the preferred neuromuscular blocking agent for RSI because it produces muscle relaxation rapidly and has a relatively brief duration of action. However, its adverse effect profile – including hyperkalemia, bradyarrhythmias, malignant hyperthermia, and increased intracranial and intraocular pressures – limits its use in certain patient populations. Rocuronium bromide, a non-depolarizing neuromuscular blocker, has emerged as a potential alternative capable of producing comparable intubating conditions at higher doses. Aim: This study aimed to evaluate and compare the efficacy of Rocuronium bromide (1.2 mg/kg) and Succinylcholine (1.2 mg/kg) with respect to intubating conditions, onset time, and hemodynamic responses during rapid sequence intubation in adult patients. Methods: A prospective, randomized clinical study was performed involving 80 adult patients classified as ASA physical status I and II who were scheduled for elective surgery under general anesthesia. Participants were randomly assigned to two equal groups. Group S received succinylcholine (1.2 mg/kg), whereas Group R was administered rocuronium bromide (1.2 mg/kg). Intubating conditions were evaluated using a standardized scoring system that assessed jaw relaxation, ease of laryngoscopy, vocal cord position, and patient response to intubation, including coughing. Hemodynamic variables – such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation – were measured before induction and at predetermined time points following intubation. Results: Both neuromuscular blocking agents produced acceptable to excellent intubating conditions. No statistically significant differences were observed between the two groups regarding the quality of intubation. Succinylcholine showed a marginally faster onset, while rocuronium demonstrated slightly more stable hemodynamic responses. All differences were statistically insignificant (p > 0.05). Conclusion: Rocuronium bromide at 1.2 mg/kg offers intubating conditions comparable to succinylcholine and may serve as a safe and effective alternative, particularly when succinylcholine is contraindicated.
Keywords: Rapid sequence intubation, rocuronium bromide, succinylcholine, neuromuscular blockade, hemodynamic response, airway management
[This article belongs to Research and Reviews : A Journal of Life Sciences ]
References
- Sinclair R, Luxton MC. Rapid sequence induction. Contin Educ Anaesth Crit Care Pain. 2005;5(2):45-48. doi:10.1093/bjaceaccp/mki016.
- Appiah-Ankam J, Hunter JM. Pharmacology of neuromuscular blocking drugs. Contin Educ Anaesth Crit Care Pain. 2004;4(1):2-7. doi:10.1093/bjaceaccp/mkh002.
- Wong SF, Chung F. Succinylcholine-associated postoperative myalgia. Anaesthesia. 2000;55(2):144-152. doi:10.1046/j.1365-2044.2000.055002144.x.
- Keating GM. Sugammadex: a review of neuromuscular blockade reversal. Drugs. 2016;76(10):1041-1052. doi:10.1007/s40265-016-0604-1.
- Rosenberg H, Pollock N, Schiemann A, Bulger T, Stowell K. Malignant hyperthermia: a review. Orphanet J Rare Dis. 2015;10:93. doi:10.1186/s13023-015-0310-1.
- Khuenl-Brady KS, Sparr H. Clinical pharmacokinetics of rocuronium bromide. Clin Pharmacokinet. 1996;31(3):174-183. doi:10.2165/00003088-199631030-00002.
- Sluga M, Ummenhofer W, Studer W, Siegemund M, Marsch SC. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases. Anesth Analg. 2005;101(5):1356-1361. doi:10.1213/01.ANE.0000180196.58567.
- Pühringer FK, Khuenl-Brady KS, Koller J, Mitterschiffthaler G. Evaluation of the endotracheal intubating conditions of rocuronium (Org 9426) and succinylcholine in outpatient surgery. Anesth Analg. 1992;75(1):37-40.
- Kihara S, Brimacombe J, Yaguchi Y, Watanabe S, Taguchi N, Komatsuzaki T. Hemodynamic responses among three tracheal intubation devices in normotensive and hypertensive patients. Anesth Analg. 2003;96(3):890-895. doi:10.1213/01.ANE.0000048706.15720.C9.
- Wang L, Li H, Zhong Y, Ye S, Deng J, Pan T, Zhang Y. Comparative analysis of hemodynamic responses and oropharyngeal complications in tracheal intubation: evaluating conventional, video, and rigid video laryngoscopes under general anesthesia. Med Sci Monit. 2024;30:e944916. doi:10.12659/MSM.944916.
- Harris DE. Rocuronium-induced anaphylaxis in the perioperative period: a clinical review. AORN J. 2024;119(1):47-58. doi:10.1002/aorn.14053.
- El-Orbany M, Connolly LA. Rapid sequence induction and intubation: current controversy. Anesth Analg. 2010;110(5):1318-1325. doi:10.1213/ANE.0b013e3181d5ae47.
- Tran DTT, Newton EK, Mount VAH, Lee JS, Wells GA, Perry JJ. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2015;(10):CD002788. doi:10.1002/14651858.CD002788.pub3.
- Cooper R, Mirakhur RK, Clarke RSJ, Boules Z. Comparison of intubating conditions after administration of Org 9246 (rocuronium) and suxamethonium. Br J Anaesth. 1992;69(3):269-273. doi:10.1093/bja/69.3.269.
- Ratan Singh N, Thangluai T, Laithangbam PKS, Hemjit Singh T, Chaoba Singh L, Shanti Devi RK. Comparison of intubating conditions of succinylcholine, vecuronium and rocuronium in patients undergoing elective surgery: a study. J Med Soc. 2011;25(2):54-58.
Research and Reviews : A Journal of Life Sciences
| Volume | 16 | |
| Issue | 02 | |
| Received | 18/02/2026 | |
| Accepted | 06/07/2026 | |
| Published | 07/07/2026 | |
| Publication Time | 139 Days |