Low-dose rocuronium with ephedrine pretreatment vs. high-dose rocuronium atone for rapid sequence induction: A randomized controlled trial

Abstract

Rocuronium bromide is increasingly used as an alternative to succinylcholine in rapid sequence induction (RSI). Optimizing its onset time and intubation conditions remains an area of active investigation. Ephedrine pretreatment has been used to enhance the effect of rocuronium by increasing cardiac output and muscle perfusion. To compare intubation conditions and hemodynamic responses between patients receiving a lower dose of rocuronium with ephedrine pretreatment and those receiving a high dose of rocuronium without pretreatment. Randomized controlled trial. Fifty adult patients scheduled for elective surgery under general anesthesia were assigned to one of two groups: (l) ephedrine pretreatment (70 gg/kg) followed by rocuronium 0.6 mg/kg, or (2) rocuronium 1.2 mg/kg with no pretreatment. Intubation conditions were evaluated one minute after rocuronium administration using the updated Stockholm Consensus criteria of Good Clinical Research Practice in pharmacodynamic studies of neuromuscular blocking agents (NMBAs). Secondary outcomes included changes in heart rate (HR) and mean Arterial Pressure (MAP). Rates of excellent and clinically acceptable (excellent + good) intubation conditions were comparable between the two groups (72% vs. 84%, p = 0.508 and 92% vs. 96%, p = 1000 respectively). HR and MAP were higher after induction in the ephedrine group but remained within clinically safe limits. Ephedrine pretreatment with a lower dose of rocuronium yields intubation conditions equivalent to those achieved with a higher rocuronium dose, with stable and acceptable hemodynamic profiles. This approach luay allow for reduced NMBA dosing without compromising intubation success