Comparison of intubating conditions and hemodynamics during rapid sequence induction and intubation using propofol and rocuronium with low dose ephedrine and without ephedrine

Abstract

Background: Rocuronium, a non-depolarizing neuromuscular blocking agent, has been used for rapid sequence induction and intubation, as it has rapid onset and acceptable intubating conditions at higher doses. Propofol, when used as an induction agent reduces cardiac output, thereby may decrease delivery of neuromuscular blocking agent at neuromuscular junction and thereby time of onset of action of rocuronium can be increased. Ephedrine has been described to speed up the onset of action of rocuronium and provide better intubating conditions during induction of anesthesia. We conducted this study to quantify the effect of ephedrine on intubation conditions and hemodynamic profile during induction of general anesthesia with propofol and rocuronium. Methodology: Sixty adult patients of ASA Grade 1 and 2, aged between 18-55 years scheduled for various elective surgeries under general anesthesia, were randomly allocated into two groups with 30 patients in each group; Group A (n = 30) received inj ephedrine 70 μg/kg followed one minute later by propofol 2.5 mg/kg with rocuronium 0.6 mg/kg and Group B (n = 30) received normal saline followed one minute later by propofol 2.5 mg/kg and rocuronium 0.6 mg/kg. Intubating conditions and hemodynamic parameters were assessed in both groups. Results: The demographic data and baseline hemodynamic parameters were comparable between the two groups, (P > 0.05). However, there was a significant difference in hemodynamic parameters after induction in both groups, (P < 0.05) but clinically the difference was insignificant. The intubating conditions were significantly better in Group A as compared to Group B, (P < 0.05). Conclusion: The use of low dose ephedrine before induction with propofol and rocuronium (0.6 mg/kg) provided better intubating conditions as compared to induction with propofol and rocuronium alone at 60 seconds. The variations in hemodynamic parameters were found to be statistically significant but clinically insignificant from their baseline values. Key words: Ephedrine; Propofol; Rocuronium; Intubation, Endotracheal; Endotracheal Anesthesia; Hemodynamics; Vasoconstriction; Vasodilatation Citation: Jain K, Sethi SK, Jain N, Saini S, Khare A. Comparison of intubating conditions and hemodynamics during rapid sequence induction and intubation using propofol and rocuronium with low dose ephedrine and without ephedrine. Anaesth Pain & Intensive Care 2016;20(3):320-327 Received: 25 June 2016; Reviewed: 6 & 9 September 2016; Corrected: 12 September 2016; Accepted: 15 September 2016