Rapid induction sequence with vecuronium: should we intubate after 60 or 90 seconds?

Abstract

The purpose of the study was to determine intubating conditions after administration of either succinylcholine or vecuronium in a rapid induction sequence. Patients received either succinylcholine 1.5 mg· kg- 1 (Groups I and II) after d-tubocurarine 0.05 mg · kg- 1 four minutes earlier, or vecuronium (Groups III and IV) in an initial dose of 0.01 mg · kg- 1 followed four minutes later by 0.1 mg · kg- 1. In Groups I and III an apnoeic delay of one minute was allowed before intubation whereas in Groups II and IV the delay was 90 sec. There was no significant difference in intubating conditions between Groups I and IV. Intubating conditions in Group III (vecuronium - delay of one minute were statistically worse than in any of the three other groups. A delay of 90 sec after succinylcholine improved intubating conditions in male patients. Considering that intubating conditions obtained after 90 sec in patients given a priming sequence with vecuronium (Group IV) were not different from those obtained 60 sec after succinylcholine (Group I), the authors conclude that vecuronium is an acceptable alternative for rapid tracheal intubation. In the doses used in this study, intubating conditions 60 sec after vecuronium were unacceptable for rapid induction of anaesthesia. © 1990 Canadian Anesthesiologists.