Pancuronium rapid induction sequence

Succinylcholine is traditionally used as the muscle relaxant of choice for rapid induction sequence intubation. There are, however, many absolute and relative contraindications for the use of succinylcholine necessitating the need for an alternative muscle relaxant. This study was undertaken to evaluate the effectiveness of pancuronium bromide for muscle relaxation in the rapid induction sequence in comparison to succinylcholine. A double-blind study was undertaken in 90 patients divided into two groups: One group was intubated at 60 seconds and the other at 90 seconds. Each group was divided into four subgroups by random selection and received of the following regimens: (a) succinylcholine, 1.5 mg/kg preceded by 3 mg of d-tubocurarine; (b) pancuronium bromide, 0.1 mg/kg; (c) pancuronium bromide, 0.125 mg/kg; and (d) pancuronium bromide, 0.15 mg/kg as relaxants in rapid sequence intubation. A rapid sequence intubation was performed with each intubation by a staff member or experienced house officer. Pre- and postinduction blood pressure and heart rate were taken. Postinduction blood gases were taken. The times to completion of intubation were recorded. Cord position, ease of intubation and overall relaxation were evaluated. The results indicate that in experienced hands pancuronium bromide in a dose of 0.1-0.15 mg/kg is as an effective muscle relaxant for rapid induction sequence intubation as is succinylcholine. It is an acceptable alternative when succinylcholine is contraindicated. Intubating conditions are best 90 seconds after the administration of pancuronium bromide.