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Woman undergone general anesthesia for caesarean section, need a rapid sequence induction to protect against pulmonary aspiration.
Succinylcholine is the most commonly used muscle relaxant due to its fast onset and short duration but it has many serious complications. Rocuronium a new muscle relaxant with a brief onset of action, but devoid of the succinylcholine adverse effects may be a suitable alternative to it and to test this hypothesis, the intubating and recovery characteristic of succinyl choline ,recuronium and atracurium were compared.
This study was conducted on 60 parturients delivered by elective cesarean section . Aged 18 to 37 years and physical status ASA I and II . They were divided into 3 groups: group I was given 0.6 mg.kg-1 rocuronium (n = 20), group II was given 0.5 mg.kg-1 atracurium (n = 20) and group III was given 1 mg.kg-1 succinylcholine (n = 20). The intubation conditions were assessed. heart rate and mean arterial blood pressure were monitored before induction of general anesthesia after induction of general anesthesia and then at 1, 3, 5, 10, 15 and 20 minutes after muscle relaxant administration then every 10 minutes. Subjective TOF ratio was recorded at 0 , 1, 2 and 3 minutes from injection of the muscle relaxant and then every 5 minutes until reverse . The onset time, the clinical duration of action of the muscle relaxants , recovery time and recovery index were recorded.
The mainresults of the present study were as follow :
Rocuronium gave good and excellent intubating conditions at 60 seconds significantly higher than atracurium and comparable to intubation at 60 seconds following succinylcholine. Rocuronium had significantly shorter onset time and clinical duration than atracurium and had rapid onset of action approaching that of succinylcholine. It had significantly shorter recovery time than atracurium and had significantly lower number of patients with fade in TOF at 1 minute post its injection than atracurium. Number of patients with zero fade in TOF at 1 minute post injection ofrocuronium was significantly higher than atracurium. Rocuronium had significantly lower number of patients with no fade in TOF at 60 minutes post injection of NDMRt han atracurium.
Conclusion and Recommendations
As regarding the present study, rocuronium bromide 0.6 mg /kg can be safely used for rapid sequence induction in parturients undergoing cesarean sections and the intubating conditions are similar to those of suxamethonium.
1- Further studies on large number of patients are needed for better judgment on using rocuronium bromide as a good alternative to suxamethonium for tracheal intubation in cesarean sections .
2- Use rocuronium bromide alternative to suxamethonium for tracheal intubation in cesarean sections .
3- Any hospital should be provided by rocuronium bromide. It should be used when suxamethonium is contraindicated or when its use is hazardous.
4- Further studies on large number of patients are needed for finding the ideal neuromuscular blocking agent which has rapid onset time and offers good to excellent intubation conditions with no side effects