• Ah-Young Oh, Suk-Ju Cho, Kwang-Suk Seo, Jung-Hee Ryu, Sung-Hee Han, and Jung-Won Hwang.
• Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
• Eur J Anaesthesiol. 2013 Sep 1;30(9):550-5.

ContextFull relaxation is not mandatory for successful tracheal intubation.ObjectiveWe tried to find the dose of rocuronium that gave acceptable intubation conditions in a rapid sequence intubation with remifentanil and propofol.DesignA dose-finding study of rocuronium using a modified Dixon's up-and-down method.SettingA single tertiary care teaching hospital.ParticipantsPatients undergoing elective surgery under general anaesthesia.InterventionsAfter premedication with midazolam and glycopyrrolate, anaesthesia was induced using remifentanil 2 μg kg and propofol 2 mg kg, and a predetermined dose of rocuronium was administered. The dose of rocuronium was determined by a modified Dixon's up-and-down method starting from 0.8 mg kg with an interval of 0.1 or 0.05 mg kg. Intubation was performed 60 s after the start of the rocuronium injection. Intubation conditions were graded as excellent, good or poor. Excellent or good were regarded as clinically acceptable.Main Outcome MeasureA dose of rocuronium needed for acceptable intubation condition in 50% of patients (ED50) during rapid tracheal intubation after induction of anaesthesia with remifentanil and propofol.ResultsTwenty-eight patients were enrolled to obtain six crossovers. The ED50 of rocuronium was 0.20 mg kg (95% confidence interval, CI 0.17 to 0.23 mg kg) by a modified Dixon's up-and-down method.ConclusionAfter induction of anaesthesia with remifentanil 2 μg kg and propofol 2 mg kg, the ED50 of rocuronium for acceptable intubation condition was 0.20 mg kg (95% CI, 0.17 to 0.23 mg kg) for rapid sequence intubation. Thus, we recommend that the intubation dose should be 0.8 mg kg.Trial RegistrationClinical trial registration KCT0000094.

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