Intubation conditions after rocuronium or succinylcholine for rapid sequence induction with alfentanil and propofol in the emergency patient

Background and objective: Previous studies mainly conducted on elective patients recommend doses of 0.9-1.2 mgkg(-1) rocuronium to obtain comparable intubation conditions with succinylcholine 1.0 mgkg(-1) after 60 s during a rapid-sequence induction. We decided to compare the overall intubating conditions of standard doses of rocuroniurn 0.6 mg kg(-1) and succinylcholine 1.0 mg kg(-1) during a strict rapidmnsequence induction regimen including propofol and alfentanil. Methods: Male and female patients (ASA I-III) older than 17 yr scheduled for emergency abdominal or gynaecological surgery and with increased risk of pulmonary aspiration of gastric content were randomized to a rapid-sequence induction with succinylcholine 1.0 mg kg(-1) or rocuronium 0.6 mgkg(-1). Patients with a predicted difficult airway were excluded. A senior anaesthesiologist 'blinded' for the randomization performed the intubation 60 s after injection of the neuromuscular blocker. Intubating conditions were evaluated according to an established guideline. Tracheal intubation not completed within 30 s was recorded as failed. Results: 222 patients were randomized. Three patients had their operation cancelled and 10 did not fulfil the inclusion criteria. Clinically acceptable intubation conditions were present in 93.5% and 96.1% of patients in the succinylchollne group (n = 107) and the rocuroniurn group (n = 102), respectively (P = 0.59). Conclusions: During a rapid-sequence induction with alfentanil and propofol, both rocuronium 0.6 mg kg(-1) and succinylcholine 1.0 mg kg(-1) provide clinically acceptable intubation conditions in 60 s in patients scheduled for emergency surgery. Under the conditions of this rapid-sequence induction regimen rocuronium may be a substitute for succinylcholine.