Effect of Saline Flush and Hand Elevation on the Onset, Time and Duration of the Action of Rocuronium
Iraqi Postgraduate Medical Journal,
2020, Volume 19, Issue 3, Pages 199-204
Nondepolarizing neuromuscular blocking drugs (NMBDs) were developed as alternatives to Succinylcholine due
to its serious side effects. Rocuronium bromide has been suggested as the drug of choice when Succinylcholine is
contraindicated. Shortening the onset time of NMBDs is important in some situations, which can be achieved by
several techniques as the priming principle.
To evaluate the effect of fluid (normal saline) flush after Rocuronium bolus on the onset and
duration of action.
PATIENTS AND METHODS:
Sixty patients were divided randomly into two groups; each group had 30 patients: group (A) and group (B). All
of them have undergone surgical operations under general anesthesia. Rocuronium without normal saline was
received in induction by 30 patients (Group A), while Rocuronium followed by 20 ml normal saline flush and
hand elevation were received in induction by the other 30 patients (Group B). A peripheral nerve stimulator was
used to measure a train-of-four (TOF) stimulation. The time from the disappearance of T1 until the appearance of
T3 is the duration of the action of Rocuronium.
In this study, means of time of onset were significantly higher in Group A than that in Group B
(61.12 versus 44.41 sec, P= 0.001), and duration of action was higher in Group B than that in Group
A but statistically not significant (40.87 versus 34.61 mints, P= 0.063).
A 20 ml saline flush and hand elevation immediately after administering a Rocuronium bolus of (0.6 mg/kg)
decreased the onset time but did not significantly increase the recovery phase of Rocuronium. Therefore, we
recommend to use 20 ml Normal Saline flush and hand elevation after Rocuronium injection as a safe method to
get rapid onset for intubation especially when Suxamethonium is contraindicated
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