[Does rocuronium displace the position of suxamethonium?]

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Rapid sequence induction (RSI) is critical for patients with full stomachs to prevent gastric aspiration.
• Suxamethonium is the standard muscle relaxant for RSI due to its rapid onset and short duration.
• Suxamethonium's use is limited by potential side effects, including potassium release and membrane depolarization.

Purpose of the Study:

• To evaluate rocuronium as a potential alternative to suxamethonium for RSI.
• To compare the intubating conditions provided by rocuronium and suxamethonium.
• To assess the potential of sugammadex to reverse rocuronium's effects for safer RSI.

Main Methods:

• Review of meta-analyses comparing intubation conditions with suxamethonium and rocuronium.
• Consideration of the role of sugammadex in reversing neuromuscular blockade.

Main Results:

• A large meta-analysis indicated that suxamethonium provides superior intubating conditions compared to rocuronium.
• Rocuronium has been proposed as an alternative to suxamethonium for RSI.

Conclusions:

• Despite suxamethonium's superior intubation conditions, rocuronium may become a viable alternative for RSI.
• The availability of sugammadex (Org 25969) to rapidly reverse rocuronium is key to its potential adoption in RSI protocols.