Comparison of intubating conditions and hemodynamic effects of a combination of rocuronium and vecuronium with rocuronium or vecuronium used alone in patients undergoing elective lower abdominal and perineal surgery

Aim: Neuromuscular blockers are drugs used to facilitate endotracheal intubation and to improve surgical working conditions during general anesthesia. Rocuronium with rapid onset of action acts synergistically with other nondepolarizing agents. The purpose of this study was, therefore, to compare onset time, clinical duration, intubating conditions, and hemodynamic changes with rocuronium, vecuronium, and a combination of rocuronium and vecuronium. Methodology: This prospective, randomized, double-blind, controlled comparative study included 150 American Society of Anesthesiologist Grade I or Grade II adult patients, scheduled for elective lower abdominal (gynecological and general surgical) and perineal surgery requiring general anesthesia with endotracheal intubation. The tracheal intubation conditions were evaluated on the first attempt and scored on a scale described by Clarke and Mirakhur (excellent, good, poor, and inadequate). In addition to routine cardiovascular monitoring, hemodynamic parameters were specifically noted before the administration of the intubating dose of study drug and 1, 2, 5, 10, and 15 min thereafter. Results: In rocuronium group and rocuronium and vecuronium combination groups, excellent and good intubation conditions were achieved in 78% and 22% of cases as compared to 42% and 58% in vecuronium group, respectively. Conclusion: The drug combination can provide a clinically comparable condition for tracheal intubation with near similar hemodynamic parameters as compared with rocuronium alone. This further points out toward the fact that the combination of rocuronium with vecuronium can be economical alternative for rapid intubation in elective surgical cases.