Comparison of intubating conditions and haemodynamic responses during rapid tracheal intubation using either suxamethonium or rocuronium with ephedrine pretreatment

Background: Suxamethonium is considered as the “gold standard” for tracheal intubation. Because of innumerable contraindications for the use of this drug, there is a continuous search for other alternatives. Methods: In a prospective, randomized and double-blind study, we compared the intubating conditions and haemodynamic responses during rapid tracheal intubation using either suxamethonium or rocuronium with ephedrine pretreatment. We recruited 50 patients and allocated them into 2 groups (n= 25 each); Group S: received suxamethonium 1.5 mg/kg and Group R: received rocuronium 0.6 mg/ kg with ephedrine 100 μg/kg pretreatment. All patients were induced with 2 mg/kg propofol and intubation was attempted at 60 seconds. Haemodynamic responses and quality of intubating conditions were assessed. Results: Both groups were comparable in respect to age, sex, weight, Mallampati grade, Cormack Lehane grade and duration of laryngoscopy. Although both groups had clinically acceptable intubating conditions (good and excellent), there were more number of patients with better intubation score in Group S compared to Group R (p = 0.014). Conclusion: Suxamethonium still continues to be the “gold standard” for providing ideal tracheal intubation conditions. However, in conditions where suxamethonium is contraindicated, rocuronium-ephedrine combination can be used as an alternative to intubate the trachea at 60 seconds.