Rocuronium versus succinylcholine: a clinical comparison of two muscle relaxants for rapid sequence induction of anaesthesia

Abstract

Background:  In emergencies, some cases need a general anaesthetic with endotracheal intubation. It is imperative to have fast acting medications to allow clinicians to complete this procedure quickly and safely. Succinylcholine is currently the most used muscle relaxant. It is fast acting and lasts only for a few minutes and is very desirable in such settings. In certain cases, succinylcholine cannot be used as it causes disturbances in salt balance such as hyperkalaemia and other adverse reactions. An equally effective anaesthetic without such undesirable side effects would be advantageous. One such possible alternative is rocuronium, a muscle relaxant which has fewer side effects but a longer duration of action. Our study compares rocuronium versus succinylcholine for rapid sequence induction of anaesthesia. Methods: 80 adult cases ranging in age from 20 to 50 years with ASA Grade I & II, Mallampatti Grade I and II and requiring emergency surgery under general anaesthesia were selected for this study. Cases were randomly allocated into 2 groups containing 40 cases each. Cases in Group I received Succinylcholine 2mg/kg body weight and those in Group II received rocuronium 0.6mg/kg body weight. Results:  Succinylcholine is still the drug of choice in emergencies where rapid sequence of anaesthesia is needed for intubation with rapid onset, rapid recovery and profound relaxation. The action profile of Succinylcholine is unmatched even 50 years after its introduction into anaesthetic practice. This is probably why Succinylcholine, despite its many adverse effects and partly life-threatening side effects, is still considered indispensable by many anaesthetists and emergency doctors. To avoid the complications of Succinylcholine many new and old non-depolarizing drugs have been tried but Succinylcholine still remains the drug of choice for tracheal intubation in emergencies and full stomach. Conclusions:  Both rocuronium and succinylcholine are effective and potent muscle paralytic agents. Rocuronium has emerged as the muscle relaxant of choice in only in cases where Succinylcholine is contraindicated. Succinylcholine remains the anaesthetic medication of choice for rapid induction in adults. An ideal anaesthetic neuromuscular blocking agent should have properties similar to Succinylcholine.