• M K Sørensen, C Bretlau, M R Gätke, A M Sørensen, and L S Rasmussen.
• Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. martin@kryspin.dk
• Br J Anaesth. 2012 Apr 1;108(4):682-9.

BackgroundAn unanticipated difficult airway may arise during rapid sequence induction and intubation (RSII). The aim of the trial was to assess how rapidly spontaneous ventilation could be re-established after RSII. We hypothesized that the time period from tracheal intubation to spontaneous ventilation would be shorter with rocuronium-sugammadex than with succinylcholine.MethodsThis randomized and patient- and observer-blinded trial was approved by the regional Ethics Committee and the Danish Medicines Agency. We included elective surgical patients undergoing general anaesthesia for RSII using alfentanil (10 µg kg(-1)), propofol (2 mg kg(-1)), and either succinylcholine (1 mg kg(-1)) or rocuronium (1 mg kg(-1)). Sugammadex (16 mg kg(-1)) was given in the rocuronium group after tracheal intubation. The primary endpoint was the time from correct placement of the tracheal tube to spontaneous ventilation, defined as a respiratory rate of more than 8 bpm and a tidal volume of at least 3 ml kg(-1) for 30 s.ResultsWe included 61 patients; of whom, 55 were evaluated for the primary endpoint. The median time from tracheal intubation to spontaneous ventilation was 406 s with succinylcholine and 216 s with rocuronium-sugammadex (P = 0.002). The median time from tracheal intubation to 90% recovery of the first twitch in train-of-four (T(1) 90%) was 518 s with succinylcholine and 168 s with rocuronium-sugammadex (P < 0.0001). Intubation conditions and time to tracheal intubation were not significantly different.ConclusionsRSII with rocuronium followed by reversal with sugammadex allowed earlier re-establishment of spontaneous ventilation than with succinylcholine.

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