Rapid tracheal intubation with atracurium ― a comparison of priming intervals

• Published in: Canadian Anaesthetists' Society journal Vol. 33; no. 2; pp. 150 - 156
• Main Authors: MOHAMED NAGUIB, GYASI, H. K, MOHAMED ABDULATIF, ABSOOD, G. H
• Format: Journal Article
• Language: English
• Published: Toronto, ON Canadian Anaesthetists' Society 01.03.1986
• Subjects: Adolescent; Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Atracurium; Biological and medical sciences; Drug Administration Schedule; Electric Stimulation; Female; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Intubation, Intratracheal; Isoquinolines - administration & dosage; Male; Medical sciences; Middle Aged; Myography; Neuromuscular Junction - drug effects; Neuromuscular Nondepolarizing Agents - administration & dosage; Human; General anesthesia; Non depolarisant myorelaxant; Intubation; Trachea
• ISSN: 0008-2856; 1496-8975
• DOI: 10.1007/BF03010824

To determine the optimal interval between the administration of the priming dose and the intubating dose, atracurium was given to 44 patients either in a single dose of 0.5 mg X kg-1 or in an initial dose of 0.06 mg X kg-1 followed two, three or five minutes later with 0.44 mg X kg-1. When atracurium was given as a single bolus of 0.5 mg X kg-1 the time to 100 per cent twitch suppression (onset time) was 90.9 +/- 36 (mean +/- SD) seconds. When the priming interval was two minutes, the onset time of the intubating dose was 76.6 +/- 42.2 seconds (p = NS). But when the priming interval was three or five minutes, the onset times were 42.2 +/- 16.5 (p less than 0.01) and 52.6 +/- 28.8 (p less than 0.05) seconds respectively. Waiting for five minutes after the administration of the priming dose did not improve the intubating conditions. It is concluded that three minutes appears to be the optimal time interval for the administration of atracurium in divided doses. When a priming dose of atracurium is given three minutes before the intubating dose, it can provide an alternative to succinylcholine for rapid endotracheal intubation.