Intervention Review

Rocuronium versus succinylcholine for rapid sequence induction intubation

  1. Jeffrey J Perry1,*,
  2. Jacques S Lee2,
  3. Victoria AH Sillberg1,
  4. George A Wells3

Editorial Group: Cochrane Anaesthesia Group

Published Online: 23 APR 2008

Assessed as up-to-date: 20 AUG 2007

DOI: 10.1002/14651858.CD002788.pub2

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.

Author Information

  1. 1

    The Ottawa Hospital, Clinical Epidemiology Programme, Ottawa, Ontario, Canada

  2. 2

    Sunnybrook and Women's College Health Sciences Centre, Emergency Department, Toronto, Canada

  3. 3

    University of Ottawa Heart Institute, Cardiovascular Research Reference Centre, Ottawa, Ontario, Canada

*Jeffrey J Perry, Clinical Epidemiology Programme, The Ottawa Hospital, 1053 Carling Avenue, F6 Clinical Epidemiology Programme, Ottawa, Ontario, K1Y 4E9, Canada. jperry@ohri.ca.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 23 APR 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

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.

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

Succinylcholine created superior intubation conditions to rocuronium when comparing both excellent and clinically acceptable intubating conditions.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Rocuronium與succinylcholine於快速誘導插管之比較

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(metaanalysis)是我們考科藍2003年初次系統性回顧的更新版本。

目標

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。

搜尋策略

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。

選擇標準

我們納入了所有符合納入標準(比較rocuronium與succinylcholine,插管條件之主要結果)的試驗。

資料收集與分析

為了分組隱匿,兩位作者(JP、JL或VS)獨立擷取資料並評估其方法之品質。我們用隨機作用模型的相對危險分析綜合RevMan的結果。

主要結論

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。

作者結論

無論比較優良的插管條件或臨床尚可接受的插管條件,Succinylcholine都比rocuronium更好。

翻譯人

本摘要由臺灣大學附設醫院鄭孝良翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

緊急情況中,某些病人需要以氣管內管(幫助他們呼吸的管子)進行全身麻醉。有快速作用的藥物讓醫師快速安全的完成這個步驟是相當重要的。目前達成這個要求最常用的肌肉鬆弛劑是succinylcholine。Succinylcholine作用快速,而且只持續數分鐘,因此最能符合此需要。然而,某些病人因為它會造成嚴重的電解值失衡及特殊反應而無法使用此藥物,因此我們需要一個相同有效而沒有這些副作用的藥物。這個統合分析比較了一個可能的替代藥物rocuronium,包含插管條件品質(醫師快速安全插管的容易程度)。在此次回顧,我們合併了37個研究,包括2690個病人,比較succinylcholine與rocuronium於插管條件的影響。我們發現rocuronium於製造優良插管條件上效果遜於succinylcholine。因此Rocuronium應該僅能在succinylcholine已知不應使用之情形下作為替代藥物。