Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942004000200007
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação das condições de intubação traqueal com rocurônio aos 60 segundos em crianças, adultos e idosos

Tracheal intubation conditions at 60 seconds in children, adults and elderly patients

Maria Cristina Simões de Almeida; Rogério Silveira Martins; Ana Lúcia Costa Martins

http://dx.doi.org/10.1590/S0034-70942004000200007 Braz J Anesthesiol, vol.54, n2, p.204-211, 2004
PDF Português
PDF English
Downloads: 0
Views: 1002

Resumo

JUSTIFICATIVA E OBJETIVOS: O rocurônio apresenta um início de ação mais rápido do que todos os outros bloqueadores neuromusculares adespolarizantes disponíveis comercialmente, permitindo a intubação traqueal em tempo similar ao da succinilcolina. Além do relaxamento das cordas vocais, também é importante para uma intubação rápida e segura, em que não haja reação ao tubo traqueal ou tosse após a sua colocação. Esse trabalho tem por objetivo comparar as condições de intubação traqueal com rocurônio (0,6 mg.kg-1) com escala clínica em crianças, adultos e idosos. MÉTODO: Após medicação pré-anestésica com midazolam, monitorização de rotina e indução da anestesia com propofol e fentanil, foram avaliadas, por escala clínica, as condições de intubação traqueal após 60 segundos, em 60 pacientes com idades entre 1 e 88 anos, estado físico ASA I a III, que receberam rocurônio (0,6 mg.kg-1) em 5 segundos. Os pacientes foram divididos em três grupos de acordo com a faixa etária: Grupo 1 (G1) crianças de até 12 anos, Grupo 2 (G2), adultos de 18 a 65 anos e Grupo 3 (G3), pacientes acima de 65 anos. Foram analisados os seguintes parâmetros: as condições de intubação traqueal por escala clínica, a pressão arterial e o pulso, aferidos antes (controle),após a indução, após a injeção de rocurônio, 3 e 5 minutos após a intubação traqueal. RESULTADOS: Todos os pacientes foram intubados com sucesso em 60 segundos, mas as condições clinicamente aceitáveis em 100% dos casos só foram obtidas nos adultos e idosos. Três crianças foram classificadas como em condições ruins devido à presença de tosse sustentada por mais de 10 segundos. Não houve alterações significativas da pressão arterial nem da freqüência do pulso durante o estudo. CONCLUSÕES: Nas condições desse estudo, a dose de 0,6 mg.kg-1 foi suficiente para intubação traqueal em 60 segundos em adultos e idosos. No entanto, foi insuficiente para obtenção de condições de intubação traqueal clinicamente aceitáveis em 60 segundos em 100% das crianças.

Palavras-chave

BLOQUEADORES NEUROMUSCULARES, BLOQUEADORES NEUROMUSCULARES, INTUBAÇÃO TRAQUEAL

Abstract

BACKGROUND AND OBJECTIVES: Rocuronium has the fastest onset as compared to all other available nondepolarizing neuromuscular blockers, allowing tracheal intubation time similar to succinylcholine's. In addition to vocal cords relaxation, it is also important that there is no tube reactions (bucking) or coughing after its placement, in order to achieve fast and safe tracheal intubation. This study aimed at comparing intubation conditions after 0.6 mg.kg-1 rocuronium at 60 seconds in children, adults and elderly patients. METHODS: Following premedication with midazolam, routine monitoring and induction with fentanyl and propofol, intubation conditions at 60s were evaluated according to clinical criteria in 60 ASA I-III patients aged 1 to 88 years who received 0.6 mg.kg-1 rocuronium in 5 seconds. Patients were divided in three groups according to age: Group 1 (G1) children up to 12 years of age; Group 2 (G2), adults aged 18 to 65 years; Group 3 (G3) patients above 65 years of age. The following parameters were evaluated: tracheal intubation conditions by clinical criteria, blood pressure and pulse measured before induction (control), after induction, after rocuronium injection, 3 and 5 minutes after tracheal intubation. RESULTS: All patients were successfully intubated in 60s, but clinically acceptable conditions in 100% of cases were only achieved in adults and elderly patients. Three children were classified as having unacceptable conditions due to sustained cough for more than 10 seconds. There were no significant changes in blood pressure or pulse during the study. CONCLUSIONS: In the conditions of our study, 0.6 mg.kg-1 rocuronium was sufficient for tracheal intubation in 60 seconds in adult and elderly patients. It was, however, insufficient for clinically acceptable tracheal intubation conditions in 60 seconds in 100% of children.

Keywords

NEUROMUSCULAR BLOCKERS, NEUROMUSCULAR BLOCKERS, TRACHEAL INTUBATION

References

Wierda JM, Kleef UW, Lambalk LM. The pharmacodynamics and pharmacokinetics of Org 9426, a new non-depolarizing neuromuscular blocking agent, in patients anaesthetized with nitrous oxide, halothane and fentanyl. Can J Anaesth. 1991;38:430-435.

Scheiber G, Ribeiro FC, Marichal A. Intubating conditions and onset of action after rocuronium, vecuronium, and atracurium in young children. Anesth Analg. 1996;83:320-324.

England AJ, Margarson MP, Feldman SA. Tracheal intubation conditions after one minute: rocuronium and vecuronium, alone and in combination. Anaesthesia. 1997;52:336-340.

McCourt KC, Salmela L, Mirakhur RK. Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia. Anaesthesia. 1998;53:867-871.

Puhringer FK, Khuenl-Brady KS, Koller J. Evaluation of the endotracheal intubating conditions of rocuronium (ORG 9426) and succinylcholine in outpatient surgery. Anesth Analg. 1992;75:37-40.

Nonneman B, Merhai MC, Teerlinck L. Evaluation of intubation conditions after rocuronium bromide in patients older than 65 yr. Br J Anaesth. 1997;78:(Suppl1):A286.

McDonald PF, Sainsbury DA, Laing RJ. Evaluation of the onset time and intubation conditions of rocuronium bromide in children. Anaesth Intensive Care. 1997;25:260-261.

Andrews JI, Kumar N, van den Brom RH. A large simple randomized trial of rocuronium versus succinylcholine in rapid-sequence induction of anaesthesia along with propofol. Acta Anaesthesiol Scand. 1999;43:4-8.

Dobson AP, McCluskey A, Meakin G. Effective time to satisfactory intubation conditions after administration of rocuronium in adults. Comparison of propofol and thiopentone for rapid sequence induction of anaesthesia. Anaesthesia. 1999;54:172-176.

Viby-Mogensen J, Engbaek J, Eriksson LI. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996;40:59-74.

Sparr HJ, Mitterschiffthaler G. Are only large doses of rocuronium an alternative to succinylcholine for rapid-sequence induction?. Anesthesiology. ;80:1994.

Meistelman C, Plaud B, Donati F. Rocuronium (ORG 9426) neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis in humans. Can J Anaesth. 1992;39:665-669.

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;77:339-342.

Engbaek J, Viby-Mogensen J. Can rocuronium replace succinylcholine in a rapid-sequence induction of anaesthesia?. Acta Anaesthesiol Scand. 1999;43:1-3.

Gill RS, Scott RP. Etomidate shortens the onset time of neuromuscular block. Br J Anaesth. 1992;69:444-446.

Khuenl-Brady KS, Agoston S, Miller RD. Interaction of ORG 9426 and some of the clinically used intravenous anaesthetic agents in the cat. Acta Anaesthesiol Scand. 1992;36:260-263.

Olkkola KT, Tammisto T. Quantifying the interaction of rocuronium (ORG 9426) with etomidate, fentanyl, midazolam, propofol, thiopental, and isoflurane using closed-loop feedback control of rocuronium infusion. Anesth Analg. 1994;78:691-696.

Iwasaki H, Ohmori H, Yamauchi M. Differential effects of propofol, thiamylal and ketamine on the cricothyroid and posterior cricoarytenoid muscles of the canine larynx. Can J Anaesth. 1996;43:39-43.

Scheller MS, Zornow MH, Saidman LJ. Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil. Anesth Analg. 1992;75:788-793.

Hovorka J, Honkavaara P, Korttila K. Tracheal intubation after induction of anaesthesia with thiopentone or propofol without muscle relaxants. Acta Anaesthesiol Scand. 1991;35:326-328.

Kinder Ross A, Dear G, Dear RB. Onset and recovery of neuromuscular blockade after two doses of rocuronium in children. J Clin Anesth. 1998;631:631-635.

Lack JA, Stuart-Taylor ME. Calculation of drug dosage and body surface area of children. Br J Anaesth. 1997;78:601-605.

Crul JF, Vanbelleghens V, Buyse L. Rocuronium with alfentanil and propofol allows intubation within 45 seconds. Eur J Anaesthesiol. 1995;12:(Suppl 11):111-112.

Woelfel SK, Brandom BW, Cook DR. Effects of bolus administration of ORG-9426 in children during nitrous oxide-halothane anesthesia. Anesthesiology. 1992;76:939-942.

Hopkinson JM, Meakin G, McCluskey A. Dose-response relationship and effective time to satisfactory intubation conditions after rocuronium in children. Anaesthesia. 1997;52:428-432.

Meretoja OA. Neuromuscular blocking agents in paediatric patients: influence of age on the response. Anaesth Intensive Care. 1990;18:440-448.

Fuchs-Buder T, Tassonyi E. Intubating conditions and time course of rocuronium-induced neuromuscular block in children. Br J Anaesth. 1996;77:335-338.

Keneally JP, Gootnetilleke PH, Ramzan IM. Delayed onset of alcuronium effect in children with cyanotic congenital heart-disease. Anesth Intensive Care. 1993;1:197-200.

Brandom B. Muscle Relaxants in infants and children: How they differ from adults. ASA Refresher Courses Lecture. 1996;24:14-19.

Matteo RS, Ornstein E, Schwartz AE. Pharmacokinetics and pharmacodynamics of rocuronium (ORG9426) in elderly surgical patients. Anesth Analg. 1993;77:1193-1197.

de Almeida MC, Latorre F, Gervais HW. The effects of age on onset and recovery from atracurium, rocuronium and vecuronium blockade. Anaesthesist. 1996;45:903-906.

D'Honneur G, Kirov K, Slavov V et al. Effects of an intubating dose of succinylcholine and rocuronium on the larynx and diaphragm: an electromyographic study in humans. Anesthesiology. 1999;90:951-955.

Sparr HJ, Mellinghoff H, Blobner M. Comparison of intubating conditions after rapacuronium (ORG9487) and succinylcholine following rapid sequence induction in adult patients. Br J Anaesth. 1999;82:537-541.

Weiss JH, Gratz I, Goldberg ME. Double-blind comparison of two doses of rocuronium and succinylcholine for rapid-sequence intubation. J Clin Anesth. 1997;9:379-382.

Wierda JM, de Wit AP, Kuizenga K. Clinical observations on the neuromuscular blocking action of ORG 9426, a new steroidal non-depolarizing agent. Br J Anaesth. 1990;64:521-523.

Kirkegaard-Nielsen H, Caldwell JE, Berry P. Optimal doses for rapid-sequence intubation with rocuronium. Anesthesiology. 1997;87:A834.

5dd7f1000e8825e80413f287 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections