Comparative Evaluation of Effect of Bolus Injection of Saline with Arm Elevation on the onset Time of Different Dosages of Rocuronium
Journal Title: International Journal of Contemporary Medical Research - Year 2017, Vol 4, Issue 3
Abstract
Introduction: Shortening the onset time of neuromuscular blocking drugs is important in some situations. Several protocols have been proposed for this purpose, including the use of the priming principle or timing principle, and administration of large doses but are associated with side effects. This study was designed to evaluate the effect of bolus injection of saline with arm elevation on the onset time of different dosages of rocuronium. Material and methods: After approval of the Institutional Review Board, this randomized controlled study was conducted in 64 adult ASA I/II patients of 18-60 years age group of either sex scheduled for elective minor surgery. Patients were randomized into 4 groups - Group R6 (n=16) –Patients who received 0.6 mg/ kg rocuronium. Group RS6 (n=16) –Patients who received 0.6 mg/kg rocuronium followed by 20 mL saline push over 5 seconds and hand elevation. Group R9 (n=16) –Patients who received 0.9 mg/kg rocuronium. Group RS9 (n=16) –Patients who received 0.9 mg/kg rocuronium followed by 20mL saline- push over 5 seconds and hand elevation. Rocuronium at specified dosages was administered over 2-3 sec into a rapidly running infusion through a T-port in the intravenous (IV) line. In the bolus saline group R6 patients received 0.6 mg/kg rocuronium without saline- push or hand raise, whereas in RS6, 0.6 mg/kg rocuronium followed by 20 mL saline was pushed over 5 seconds into IV line while maintaining the arm elevated vertically. The other group R9 received 0.9 mg/kg rocuronium, and group RS9 was given the same dose of rocuronium followed by 20 ml saline- push over 5 seconds with straight hand elevation. Results: Our primary outcome, onset time was found to be 89.94 ± 3.45 sec and 77.31 ± 3.09 sec for the Group R6 and RS6 respectively, which was statistically significant with a p value of <0.001. Similarly, onset time was found to be 75.19 ± 2.86 sec and 62.63 ± 2.22 sec for the Group R9 and RS9, which was statistically significant with a p value of < 0.001. Lag time was found to be 38.38 ± 2.87 sec and 31.06 ± 2.84 sec for the Group R6 and RS6 respectively, which was statistically significant with a p value of < 0.001. Similarly, lag time for the Group R9 and RS9 was found to be 32.13 ± 2.78 sec and 24.19 ± 3.23 sec, which was also statistically significant with a p value of < 0.001. 100% clinically acceptable intubation conditions were achieved in all the patients and the intubating conditions were not statistically significant between the groups. Conclusion: Intravenous bolus injection of saline plus arm elevation shortens the onset time and lag time of rocuronium. 100% clinically acceptable intubation conditions were achieved in all the patients and time to 25% recovery of T1 was found to be comparable between the control and bolus saline groups.
Authors and Affiliations
Garima Anant, Vineet Kumar
Keywords
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