Intubating Conditions and First Pass Success Rate with Low Dose Rocuronium during Rapid Sequence Intubation: A Cross-sectional Study

Introduction: Emergency Rapid Sequence Intubation (RSI) aims to reduce complications such as pulmonary aspiration, prolonged intubation with hypoxia and the occurrence of a crash airway, while making rapid intubation safer and easier. Rocuronium, a non depolarising muscle relaxant with a prolonged neuromuscular blockade, was used to create “Modified RSI.” The first-pass success rates of rocuronium in the Indian population have not been extensively studied. Therefore, investigations in adult patients are essential to link it to an anticipated troublesome airway. Aim: To determine the first-pass success rates in patients needing RSI and to investigate whether paralysis with a low dosage of rocuronium provides clinically acceptable intubating conditions. Materials and Methods: A cross-sectional study was carried out involving all adult patients admitted to the Department of Emergency Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India, from March 2021 to November 2022, who required emergent intubation. The vital signs of every adult patient who arrived at the ED were monitored and categorised appropriately. Basic resuscitation techniques were administered to unstable patients. Informed consent was obtained and patients who met the inclusion and exclusion criteria were grouped. Data were gathered using a standard data collection form. The arithmetic mean, standard deviation, or median value were used to convey quantitative data, whereas proportions were used to express qualitative factors. Fisher’s-exact test was employed to test associations between qualitative factors, while the t-test was used to examine the relationship between qualitative and quantitative data. Results: The mean age of the study participants was 64.30±14.49 years. A low dose of rocuronium (0.3 mg/kg) produced the best intubation conditions. Fisher’s exact test indicated that patients with good/easy intubating conditions had a failure rate of 5% and 8.1% at 60 and 90 seconds, respectively, while patients with challenging intubation settings had a failure rate of 100% at both time points. With a p-value of <0.001, the association between the intubating conditions at 60 and 90 seconds and the success rate of intubation on the first attempt was determined to be statistically significant. Conclusion: The present study concluded that a dose of 0.3 mg/kg of rocuronium produced satisfactory laryngeal relaxation, increasing the success rate of intubation on the first attempt.