Key result
The combination of rocuronium and vecuronium produced acceptable intubating conditions in 93.3% of patients at 90 seconds, which was significantly better than vecuronium alone (13.3%) and comparable to rocuronium alone.
Why the study?
Does the combination of rocuronium and vecuronium improve intubating conditions and maintain haemodynamic stability compared to either drug alone in patients undergoing elective surgeries?
RCT (n=90)
Double-blind
Randomized
Does the combination of rocuronium and vecuronium improve intubating conditions and maintain haemodynamic stability compared to either drug alone in patients undergoing elective surgeries?
Absolute Event Rate: 93.3% vs 13.3%
p-value: p=<0.05
The combination of rocuronium and vecuronium provides excellent intubating conditions at 90 seconds comparable to rocuronium alone, while maintaining haemodynamic stability, offering a cost-effective alternative for rapid sequence induction.
Supports combination as cost-effective option for rapid-sequence induction; extends single-agent neuromuscular blocker comparisons in elective surgery.
BACKGROUND: Vecuronium has a slow onset of action (2-3 mins) which limits its use in situations requiring rapid establishment of airway. Rocuronium can provide good intubating conditions within 90sec but it is not used routinely because of its high cost. Combination of rocuronium with vecuronium is known to produce synergism without producing any side effects. This study was under taken to evaluate the clinical benefits of the combination of rocuronium and vecuronium in terms of better haemodynamics and acceptable intubating conditions over individual drugs. METHODS: 90 ASA grade I & II patients in the age group 20-60 years of either sex scheduled for elective surgeries were randomly allocated into three groups -group V, group R, group RV with the sample size of 30 in each. After induction with fentanyl-propofol-nitrous oxide-oxygen, group V received vecuronium 0.08 mg/kg, group R received rocuronium 0.6 mg/kg and group RV received a combination of rocuronium 0.3 mg/kg with vecuronium 0.04 mg/kg. Intubation was attempted at 90sec after administration of muscle relaxant and scored according to four step scale proposed by Goldberg and colleagues. Heart rate and blood pressure were recorded before and after induction, after administration of muscle relaxant, and at 1, 2, 3, 5 and 10 minutes after intubation. RESULTS: Rocuronium and the combination group produced acceptable intubating conditions in 93.3% patients which was significantly better than that of vecuronium group (acceptable intubating conditions only in 13.3%). There were no significant changes in heart rate and mean arterial pressure (MAP) in the three groups. CONCLUSION: The combination of rocuronium and vecuronium can provide clinically comparable conditions for tracheal intubation as rocuronium alone without compromising haemodynamic stability, thus, can be an economic alternative to rocuronium for rapid sequence induction.
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Kalpana et al. (2014) conducted an RCT in Elective surgery requiring general anaesthesia (n=90). Combination of rocuronium and vecuronium vs. vecuronium 0.08 mg/kg or rocuronium 0.6 mg/kg was evaluated on Acceptable (excellent to good) intubating conditions at 90 seconds (p=<0.05). The combination of rocuronium and vecuronium produced acceptable intubating conditions in 93.3% of patients at 90 seconds, which was significantly better than vecuronium alone (13.3%) and comparable to rocuronium alone.
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