A Prospective Randomized Study Comparing Intubating Conditions With and Without Priming With Rocuronium

BACKGROUND: Rocuronium is widely used as an alternative to succinylcholine for facilitating endotracheal intubation, but at conventional doses its clinical onset may be slower. The priming technique has been proposed as a means of shortening the time to clinically acceptable intubation with non-depolarizing neuromuscular blocking agents. METHODS: In this prospective, randomized, double-blind study, 60 American Society of Anesthesiologists I-II patients aged 18-60 years undergoing elective surgery under general anesthesia were allocated into two groups (n = 30 each). The priming group received rocuronium 0.06 mg/kg intravenously, followed 3 min later by an intubating dose of rocuronium 0.6 mg/kg. The control group received normal saline followed 3 min later by rocuronium 0.6 mg/kg. The primary outcome was time to intubation after administration of the intubating dose. Intubating conditions, hemodynamic variables, oxygen saturation (SpO₂), and adverse effects were also assessed. RESULTS: The time to intubation was significantly shorter in the priming group than in the control group (68.03 ± 1.19 s vs. 100.73 ± 3.40 s, P < 0.001). Excellent intubating conditions were observed in 16 (53.3%) patients in the priming group, whereas 0 (0.0%) patients in the control group achieved this grade; good conditions were observed in the remaining 14 (46.7%) patients in the priming group and in 28 (93.3%) patients in the control group, while poor conditions occurred only in 2 (6.7%) patients in the control group (P < 0.001). Following intubation, the hemodynamic response was generally greater and more sustained in the control group, whereas the priming group demonstrated better hemodynamic stability. SpO₂ remained stable in both groups, and no adverse effects were observed. CONCLUSION: Rocuronium priming significantly reduced the time to successful tracheal intubation and improved intubating conditions compared with conventional administration without priming. It was also associated with a smaller hemodynamic response following intubation, with stable SpO₂ and no observed adverse effects.