The Effect of Magnesium Sulphate on Intubating Condition for Rapid-Sequence Induction; Comparative Study of Magnesium Sulphate versus Ketamine in Rapid Sequence Induction

Background: Rapid sequence induction is the preferred method of endotracheal intubation in the emergency setting. The rapid sequence intubation technique involves the prompt sequential administration of a predetermined dose of hypnotic agent and muscle relaxant followed by tracheal intubation within 1min of giving the muscle relaxant.Aim of Study: Test the efficacy of magnesium sulphate (MgSo4) versus ketamine to assess intubating condition (primary outcome), rocuronium onset, rocuronium duration, train-of-four ratio upon intubation, and hemodynamic variables (secondary outcomes) for rapid sequence induction.Patients and Methods: We compared magnesium sulphate with control, ketamine with regard to intubation conditions during rapid-sequence induction.Design: This is a prospective, randomized, double-blinded study.Setting: The setting is at an operating room in Ain Shams University Hospital.Patients: 75 patients scheduled for general anesthesia were randomly allocated to the following 3 groups in equal numbers.Interventions: The control received rocuronium 0.6mg/kg; the ketamine group was given 0.5mg/kg ketamine 2 minutes before 0.6mg/kg rocuronium; and the magnesium group received 50mg/kg magnesium sulphate. Intubation was initiated 50 seconds after the rocuronium injection.Measurements: Intubating condition (primary outcome), rocuronium onset, rocuronium duration, train-of-four ratio upon intubation, and hemodynamic variables (secondary outcomes) were recorded.Results: The excellent intubating condition was more frequent in the magnesium group (p b.05). Onset of neuromus-cular block was shorter in the magnesium group than in the control, ketamine, (p b.05).Conclusions: Magnesium sulphate pre-treatment was most likely to provide excellent intubating condition for rapidsequence intubation compared with the control, ketamine. However, magnesium sulphate administration is associated with a burning or heat sensation.