Prehospital tracheal intubating conditions during rapid sequence intubation: rocuronium versus vecuronium

Abstract

Introduction: The study purpose was to evaluate tracheal intubating conditions and cardiovascular effects of rocuronium (roc) and vecuronium (vec) in the transport setting.

Methods: A prospective blinded study of adult patients requiring emergency rapid sequence oral tracheal intubation using direct laryngoscopy. Patients received equipotent doses of roc 1.0 mg/kg (n = 44) or vec 0.15 mg/kg (n = 56) on an alternate day basis.

Results: Intubation was successful in 95% of patients in the vec group and 100% in the roc group. The percentage of patients having good or excellent jaw relaxation and vocal cord exposure was similar between groups (vec/79%, roc/77%). Eleven patients (vec/7, roc/4) had difficult intubation as evidenced by Grade III or IV view and more than three attempts. Five patients in the vec group had inadequate neuromuscular blockade versus 1 patient in the roc group (P = 0.17). No cardiovascular differences occurred between groups after intubation.

Conclusion: Tracheal intubating conditions and clinical evidence of complete neuromuscular blockade tended to be better after roc than after vec.