The Effect of Rapacuronium or Succinylcholine on the Duration of Action of Rocuronium
Uniformed Services University Of The Health Sciences Bethesda United States
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Understanding potential drug interactions of multiple drug therapy influences the induction agents chosen for an individual patient. The use of muscle relaxants is a common aspect of modern anesthesia practice. Succinylcholine, a depolarizing agent, has been used since 1952 but due has numerous adverse side effects. Non-depolarizing neuromuscular blocking agents achieve the same efficacy as succinylcholine without the adverse effects. Rocuronium, an intermediate acting non-depolarizer, provides an alternative for intubation when succinylcholine is not recommended. Rapacuronium, approved in 1999, has a shorter onset and duration of action than rocuronium. The goal of this study was to determine whether the duration of action of rocuronium is affected by the prior administration of rapacuronium or succinylcholine. Quantitative data was obtained from 30 volunteers randomly placed in two groups. For induction, Group A received succinylcholine and Group B received rapacuronium. Both groups received rocuronium for maintenance. The Paragraph Nerve Stimulator was used to observe the neuromuscular response return of the second twitch during the first maintenance dose of rocuronium. An independent samples t-test found no statistically significant difference p 0.111 between the study groups. The mean time for return of the second twitch in minutes for Group A was shorter 26.87 than Group B 36.20. Although the data did not yield statistical significance, there may be clinical implications of the results observed in terms of cost and reversal time. The investigators note that rapacuronium was voluntarily taken out of the market as of April 2001 but this did not affect the data.