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Rapid tracheal intubation with rocuronium: a probability approach to determining dose
H Kirkegaard-Nielsen1, J E Caldwell, P D Berry
1Department of Anesthesia and Perioperative Care, University of California, San Francisco 94143-0648, USA.
Anesthesiology
|July 28, 1999
Summary
A dose of 1.04 mg/kg rocuronium provides a 95% probability for successful tracheal intubation within 60 seconds. This study determined optimal rocuronium doses for rapid intubation success.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Rapid tracheal intubation is critical in emergency medicine.
- Rocuronium's efficacy for rapid intubation has not been previously assessed using a probability-based approach.
Purpose of the Study:
- To predict rocuronium doses yielding a 90% and 95% probability of successful tracheal intubation within 60 seconds.
- To estimate the duration of action for these predicted rocuronium doses.
Main Methods:
- Eighty subjects received midazolam, fentanyl, and propofol for anesthesia induction.
- Rocuronium doses (0.0, 0.4, 0.8, 1.2 mg/kg) were administered randomly, followed by laryngoscopy.
- Logistic regression analyzed dose-response for successful intubation; duration of action was measured by train-of-four response.
Main Results:
- Successful intubation rates varied by rocuronium dose.
- The predicted dose for 90% probability (D90) was 0.83 mg/kg, and for 95% probability (D95) was 1.04 mg/kg.
- Estimated durations of action were 32 minutes for D90 and 46 minutes for D95.
Conclusions:
- A rocuronium dose of 1.04 mg/kg ensures a 95% probability of successful tracheal intubation within 60 seconds.
- This dose is recommended for rapid sequence intubation following fentanyl and propofol induction.