European Journal of Molecular & Clinical Medicine

Vecuronium has a slow onset of action (2-3min) which limits its use in situations requiring rapid establishment of airway. Rocuronium can provide good intubating conditions within 90sec but it is not used routinely because of high cost. Combination of rocuronium with vecuronium is known to produce synergism without producing any side effects. It provides rapid onset of action and acceptable intubating conditions. This study was undertaken to evaluate the clinical benefits of the combination of rocuronium and vecuronium in terms of better haemodynamics and acceptable intubating conditions over individual drugs.
Methods: 90 ASA grade I and II patients in the age group 20-60 years of either sex scheduled for elective surgeries done under general anaesthesia were recruited for the study. They were randomly allocated into three groups - group V, group R, group RV with the sample size of 30 in each. After induction with fentanyl-propofol-nitrous oxide- oxygen, group V received vecuronium 0.08 mg/kg, group R received rocuronium 0.6 mg/kg and group RV received a combination of rocuronium 0.3 mg/kg with vecuronium 0.04 mg/kg.
Conclusion: The combination of rocuronium and vecuronium can provide clinically comparable conditions for tracheal intubation as rocuronium alone without compromising haemodynamic stability, thus, can be an economic alternative to rocuronium for intubation

Background: Rocuronium bromide, a mono quaternary amino steroid with a short onset and an intermediate duration of action, is currently one of the most commonly used neuromuscular blocking agent. In common with vecuronium, hepatic uptake & biliary excretion have been suggested to be the main mechanism of rocuronium metabolism with renal elimination accounting for 10-20% of its overall excretion. This study was conducted to investigate the neuromuscular effects of 0.6mg/kg rocuronium under general anaesthesia in patients with and without renal failure.
Methodology: This prospective observational study includes 110 patients (pts.) divided into two groups, Group ‘S’ (n=55) pts. with renal failure and Group ‘C’ (n=55) without renal failure. Neuromuscular transmission was monitored, parameters recorded were onset, time to maximal block, time to recovery of first twitch response to 25%, 50%, 75% and 90% of base line, time to recovery of train-of-four (TOF) ratio of 70% and recovery index 25% - 75%.
Results: In both the groups demographic data were similar. Both onset time and maximum block for rocuronium were comparable in group S and group C, found not significant. Time to recovery of first twitch response to 25%, 50%, 75% and 90% of baseline, time for recovery of TOF ratio to 70% and recovery index were significantly prolonged in group S compared to group C.
Conclusion: Rocuronium can be used with caution in patients with renal disease and monitoring of neuromuscular block in this group of patients is essential.