Comparison of different doses of atracurium for quality of muscle relaxation during modified rapid sequence induction in emergency laparotomy: A prospective randomised double blind study

Background and Aims: In emergency and non-fasting patients posted for laparotomy under general anaesthesia, rapid sequence induction (RSI) is preferred, and it is routinely done by using succinylcholine or rocuronium. Using higher doses of atracurium [i.e. 3-4 times the 95% effective dose (ED95)] can provide acceptable intubating conditions in a short time. The primary objective of our study was to compare two different higher doses of atracurium to achieve good intubating conditions for RSI without using a priming dose. The secondary objective was to compare the duration of muscle relaxation using neuromuscular monitoring and haemodynamic responses during and after intubation. Methods: Sixty patients were enroled and randomly assigned into two groups:-, group A1 (atracurium: 0.75 mg/kg) and group A2 (atracurium: 1 mg/kg). After premedication, anaesthesia was induced with propofol 2-2.5 mg/kg and atracurium injections, followed by intubation within a minute by trained anaesthesiologists. Meanwhile, intubating conditions, neuromuscular monitoring using train-of-four (TOF) measurements and post-tetanic-count and haemodynamics were recorded. Data were analysed statistically by using the Chi-square test and Student's t-test. Results: Excellent intubation conditions (without coughing or bucking) were attained in 56.7% of cases in group A2 and in 13.3% in group A1 (P < 0.001). Duration of muscle relaxation, measured by time until TOF is two, was more prolonged in group A2 (79.2 ± 9.2 min) than in group A1 (60.13 ± 8.7 min, P < 0.001). Conclusion: Acceptable intubating conditions can be achieved in a minute with the use of a high dose of atracurium (1 mg/kg) during RSI. Hence, atracurium can be used as an alternative drug for RSI.