Published: 2016-12-29

Rocuronium versus succinylcholine: a clinical comparison of two muscle relaxants for rapid sequence induction of anaesthesia

Ravi Ranjan Kumar, Rekha Kumari, Anil Kumar


Background: In emergencies, some cases need a general anaesthetic with endotracheal intubation. It is imperative to have fast acting medications to allow clinicians to complete this procedure quickly and safely. Succinylcholine is currently the most used muscle relaxant. It is fast acting and lasts only for a few minutes and is very desirable in such settings. In certain cases, succinylcholine cannot be used as it causes disturbances in salt balance such as hyperkalaemia and other adverse reactions. An equally effective anaesthetic without such undesirable side effects would be advantageous. One such possible alternative is rocuronium, a muscle relaxant which has fewer side effects but a longer duration of action. Our study compares rocuronium versus succinylcholine for rapid sequence induction of anaesthesia.

Methods: 80 adult cases ranging in age from 20 to 50 years with ASA Grade I & II, Mallampatti Grade I and II and requiring emergency surgery under general anaesthesia were selected for this study. Cases were randomly allocated into 2 groups containing 40 cases each. Cases in Group I received Succinylcholine 2mg/kg body weight and those in Group II received rocuronium 0.6mg/kg body weight.

Results: Succinylcholine is still the drug of choice in emergencies where rapid sequence of anaesthesia is needed for intubation with rapid onset, rapid recovery and profound relaxation. The action profile of Succinylcholine is unmatched even 50 years after its introduction into anaesthetic practice. This is probably why Succinylcholine, despite its many adverse effects and partly life-threatening side effects, is still considered indispensable by many anaesthetists and emergency doctors. To avoid the complications of Succinylcholine many new and old non-depolarizing drugs have been tried but Succinylcholine still remains the drug of choice for tracheal intubation in emergencies and full stomach.

Conclusions: Both rocuronium and succinylcholine are effective and potent muscle paralytic agents. Rocuronium has emerged as the muscle relaxant of choice in only in cases where Succinylcholine is contraindicated. Succinylcholine remains the anaesthetic medication of choice for rapid induction in adults. An ideal anaesthetic neuromuscular blocking agent should have properties similar to Succinylcholine.



Endotracheal intubation, Muscle relaxant, Rocuronium, Succinylcholine

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Abouleish E, Abboud T. Rocuronium for caesarean section. Br J Anaesth. 1994;73:336-41.

Abu-Halaweh SA, Massad IM. Rapid sequence induction and intubation with 1mg/kg Rocuronium bromide in caesarean section, comparison with suxamethonium. Saudi Med J. 2007;28(9):1393-6.

Andrews JE, Kumar N. A large simple randomized trial of Rocuronium versus Succinylcholine in rapid-sequence induction of anaesthesia along with Propofol. Acta Anaes Scand. 1999;43(l):4-8.

Pendeville P, Engbaek J, Sparr HJ. Rocuronium 2.0 or 2.5 mg/kg for rapid sequence induction: comparison with succinylcholine 1.0 mg/kg. BrJ Anaesth. 2000;85(5):724-31.

Baraka AS, Sayyid SS. Thiopental-Rocuronium versus Ketamine-Rocuronium for rapid sequence intubation in parturients undergoing caesarean section. Anesth Analg. 1997;84(1):1104-7.

Bland BA, Lawes EG, Duncan PW. Comparison of midazolam and thiopental for rapid sequence anaesthetic induction for elective cesarean section. Anesth Analg. 1987;66:1165-8.

Bynum LJ, Pierce AK. Pulmonary aspiration of gastric contents. Am Rev Resp Dis. 1976;114(6):1129-36.

Courvoisier C, Forester A. Prevention of hyperkalaemia and muscular fasciculations induced by Succinylcholine. Ann Fr Anesth Reanim. 1984;3(4):261-8.

Delboy NJ, Tomichek RC, Shields JA. The hemodynamic effects of Rocuronium in patients with coronary artery disease: Succinylcholine and Vecuronium compared. Anaesth Analg. 2002;94(5):l 100-1106.

Dobson AP, Mc Cluskey A. Effective time to satisfactory intubation conditions after administration of Rocuronium in adults. Comparison of Propofol and Thiopenthone for rapid sequence induction of anaesthesia. Anaesthesia. 1999;54:172-6.

Forstmann V, Schuh FT. Onset of the effect and intubation conditions following Atracurium, Verocuronium and Suxamethonium. Anaesthesist. 1988;37(5):311-5.

Heier T, Caldwell JE. Rapid tracheal intubation with large dose Rocuronium: a probability-based approach. Anesth Analg. 2000;90:175-9.

Lam AM, Pavlin EG, Visco E, Taraday J. Rocuronium versus Succinylcholine-Atracurium for tracheal intubation and maintenance relaxation during propofol anesthesia. J Clin Anesth. 2000;12(6):449- 53.

Martin R, Carrier J. Rocuronium is the best non-depolarizing relaxant to prevent Succinylcholine fasciculations and myalgia. Can J Anaesth. 1998;45(6):521-5.

Olkkola KT. Comparison of Rocuronium and Suxamethonium for use during rapid sequence induction of anaesthesia. Anaesthesia. 1998;53(9):867-71.

Naguib M. Neuromuscular effects of Rocuronium bromide and Mivacurium chloride administered alone and in combination. Anesthesiology. 1994;81(2):388-95.

Robertson EN, Driessen JJ, Vogt M. Pharmacodynamics of Rocuronium 0.3 mg/kg in adult patients with and without renal failure. Eur J Anaesthesiol. 2005;22(12):929-32.

Singh Ajeet, Bhatia PK , Tulsaini KL. Companion of onset time, duration of action and intubating conditions achieved with Suxamethonium and Rocuronium. Indian J Anaesth. 2004;48(2):129-33.

Sparr HJ, Giesinger S, Ulmer H. Influence of induction technique on intubating conditions after rocuronium in adults: comparison with rapid sequence induction using Thiopentone and Suxamethonium. Br J Anaesth. 1996;77(3):339-42.

Sparr HJ, Mitterschiffthaler G. Are only large doses of Rocuronium an alternative to Succinylcholine for rapid sequence induction. Anesthesiology. 1994;80:1411-2.

Weiss JH, Gratz I, Goldberg ME. Double¬blind comparison of two doses of Rocuronium and Succinylcholine for rapid sequence intubation. J Clin Anesth. 1997;9(5):379-82.

Wierda JM. Clinical observations on the neuromuscular blocking action of Rocuronium a new steroidal non-¬depolarizing agent. Br J Anaesth.1990;64(4):521-3.

Yung-Tai Chung, Liang-Tsai Yeh. Effectiveness and safety of Rocuronium for rapid sequence induction. Acta Anaesthesiol. 2001;39:3-9.