Rocuronium versus succinylcholine for rapid sequence induction intubation
Editorial Group: Cochrane Anaesthesia Group
Published Online: 23 APR 2008
Assessed as up-to-date: 20 AUG 2007
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Perry JJ, Lee JS, Sillberg VAH, Wells GA. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD002788. DOI: 10.1002/14651858.CD002788.pub2.
- Publication Status: New search for studies and content updated (conclusions changed)
- Published Online: 23 APR 2008
Patients requiring emergency endotracheal intubation often require a rapid sequence induction (RSI) intubation technique to protect against aspiration or increased intracranial pressure, or to facilitate intubation. Succinylcholine is the most commonly used muscle relaxant because of its fast onset and short duration; unfortunately, it can have serious side effects. Rocuronium has been suggested as an alternative to succinylcholine for intubation. This meta-analysis is an update since our initial Cochrane systematic review in 2003.
To determine if rocuronium creates comparable intubating conditions to succinylcholine during RSI intubation. Comparisons were made based on dose of rocuronium, narcotic use, emergency versus elective intubation, age and induction agent. The primary outcome was excellent intubation conditions. The secondary outcome was acceptable conditions.
In our initial systematic review we searched all databases until March 2000. We have updated that search and searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2007 issue 3), MEDLINE (1966 to June Week 3 2007), EMBASE (1988 to 2007 Week 26) for randomized controlled trials or controlled clinical trials relating to the use of rocuronium and succinylcholine. We included foreign language journals and handsearched the references of identified studies for additional citations.
We included all trials meeting the inclusion criteria (comparison of rocuronium and succinylcholine, main outcomes of intubation conditions).
Data collection and analysis
Two authors (JP, JL or VS) independently extracted data and assessed methodological quality for allocation concealment. We combined the outcomes in RevMan using relative risk (RR) with a random-effects model.
In our initial systematic review we identified 40 studies and included 26. In this update we identified a further 18 studies and included 11. In total, we identified 58 potential studies; 37 were combined for meta-analysis. Overall, succinylcholine was superior to rocuronium, RR 0.86 (95% confidence interval (95% CI) 0.80 to 0.92) (n = 2690). In the group that used propofol for induction, the intubation conditions were superior with succinylcholine (RR 0.88, 95% CI 0.80 to 0.97) (n = 1183). This is contrary to our previous meta-analysis results where we reported that intubation conditions were superior in the rocuronium group when propofol was used. We found no statistical difference in intubation conditions when succinylcholine was compared to 1.2mg/kg rocuronium; however, succinylcholine was clinically superior as it has a shorter duration of action.
Succinylcholine created superior intubation conditions to rocuronium when comparing both excellent and clinically acceptable intubating conditions.
Plain language summary
Comparison of two muscle relaxants, rocuronium and succinylcholine, to facilitate rapid sequence induction intubation
In emergency situations some patients need a general anaesthetic with an endotracheal tube (tube to help them breathe). It is important to have fast acting medications to allow physicians to complete this procedure quickly and safely. Currently, the muscle relaxant medication most often used to accomplish this is succinylcholine. Succinylcholine is fast acting and lasts for only a few minutes which is very desirable in this setting. However, some patients cannot use this medication as it can cause serious salt imbalances or reactions, so an equally effective medication without these side effects is desired. This meta-analysis compared one possible alternative, rocuronium, for the quality of intubation conditions (the ease with which physicians can quickly and safely pass the endotracheal tube). In this review, we have combined the results of 37 studies, with a total of 2690 patients, which compared the effects of succinylcholine versus rocuronium on intubation conditions. We have found that rocuronium is less effective than succinylcholine for creating excellent intubation conditions. Rocuronium should therefore only be used as an alternative to succinylcholine when it is known that succinylcholine should not be used.
需要緊急插管的病人經常需要使用快速誘導插管(rapid sequence induction (RSI) intubation)之技巧以避免吸入異物/食物(aspiration)或顱內壓升高，以及使插管更順利。由於起始作用快速且藥效時間短，Succinylcholine是最常用的肌肉鬆弛劑；然而，它卻有嚴重的副作用。Rocuronium已被建議為succinylcholine於插管時的替代藥物。這個統合分析(metaanalysis)是我們考科藍2003年初次系統性回顧的更新版本。
確認rocuronium是否在快速誘導插管時產生與succinylcholine相當的條件。比較的項目包括rocuronium的劑量、麻藥(narcotic)的使用、緊急或選擇性插管、年齡、以及誘導藥物。主要結果(primary outcome)為優良的插管條件。次要結果(secondary outcome)為可接受的插管條件。
我們的初次系統性回顧搜尋了直到2000年三月的所有資料庫。我們更新了該次的搜尋並且再搜尋了Cochrane Central Register of Controlled Trials (The Cochrane Library, 2007 issue 3)、MEDLINE (1966 to June Week 3 2007)、 EMBASE (1988 to 2007 Week 26)等資料庫以查詢和rocuronium與succinylcholine之使用相關的隨機對照試驗(randomized controlled trials)或臨床對照試驗(controlled clinical trials)。我們包含了外語期刊並手動查詢了各研究的相關資料已得到外加的引用。
我們的初次系統性回顧找到40個研究並納入了26個。在這次更新我們又找到了18個並納入11個。總和來說，我們找到了58個潛在的研究：37個被併入統合分析。整體來講，succinylcholine比rocuronium好，RR 0.86 (95% confidence interval (95% CI) 0.80 to 0.92) (n = 2690)。 在使用propofol進行誘導的分組中，插管條件較佳的是succinylcholine (RR 0.88, 95%CI 0.80 to 0.97)(n = 1183)。這和我們之前的統合分析相反，當時我們報告了在使用propofoal誘導時，rocuronium組的插管條件較佳。我們發現succinylcholine和1.2mg/kg劑量的rocuronium相較時，插管條件無統計上差異；然而，succinylcholine在臨床上較佳因其作用時間較短。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。