Onset time and evaluation of intubating conditions: rocuronium in perspective

The customary methods for assessment of intubating conditions, namely the onset time in the adductor pollicis muscle and qualitative rating scales of the conditions at intubation, are unsatisfactory. The onset time of neuromuscular block in the adductor pollicis is not a meaningful, quantifiable endpoint, defining optimal intubating conditions. Consequently, its meticulous recording in all studies is probably obsolete. Qualitative rating scales are very subjective and a single standardized qualitative rating scale for the assessment of intubating conditions is required in order to improve the comparability of data from various studies. Clinical studies simulating rapid sequence induction in elective patients indicate that rocuronium 0.9 mg kg-1 may be suitable for crash intubation. This, however, needs to be confirmed in emergency cases.