In message <000001bf967f$a911eb00$944f883e@dell>, John Apps
<[log in to unmask]> writes
>I have found some papers that suggest rocuronium may be a substitute for
>suxamethonium; however they refer to in-hospital use and state that further
>investigation is needed for emergency situations. Intubation time did not
>differ between the 2 agents, although the 'condition of the vocal cords' was
>better in the suxamethonium patients. The optimal dose of rocuronium seems
>to be 1mg/kg which will take ~50 minutes to wear off according to one of the
>papers.
>
>Advantages
>One less drug to carry.
>No need to keep drug cool or replace every 4 weeks.
>Reversal may be an option with neostigmine/glycopyrrolate (an extra drug to
>carry!)
>
>Disadvantages
>Rocuronium takes much longer to wear off, should you run into problems
>achieving effective ventilation.
>
>Has anyone abandoned suxamethonium in favour of rocuronium?
>I would be interested in the lists comments.
>
>John Apps
>Basics North East
>
>References
>rocuronium vs suxamethonium: are they equally effective during RSI
>Anesthesia & Analgesia. 87(6):1259-62, 1998 Dec
>
>Comparison of intubating conditions after rocuronium & suxamethonium
>Acta Anaesthesiologica Scandinavica. 40(4):425-30, 1996 Apr
>
>Rocuronium for RSI of emergency dept patients
>Journal of Emergency Medicine. 17(4):611-6, 1999 Jul-Aug
>
>Effective time to satisfactory intubation conditions after roc
>Anaesthesia. 54(2):172-6, 1999 Feb
>
>A large simple randomised trial of rocuronium vs suxamethonium in rsi
>Acta Anaesthesiologica Scand 43(1):4-8, 1999 Jan
>
>Comparison of rocuronium & suxamethonium for use during rsi
>Anaesthesia 53(9):867-71, 1998 Sept
>
>
>
Sounds great, but I have one very serious objection to Rocuronium.
When an emergency situation unfolds, your perception of time alters.
With any paralysing agent, unless you intubate after a measured period
of time, you may encounter the cords in a "less than optimal state".
With a slow circulation, the correct time to intubate is longer.
Suxamethonium is a depolarising agent. You see the fasciculation. When
it stops, it's tube time!
With rocuronium, you have no such visual indication.
Anyone disagree?
--
Steve Hughes SpR Harlow & Newham
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|