Hypothesis: Early administration of rocuronium improves the efficiency of mask ventilation and shortens the time to tracheal intubation compared with late administration
Methods: Authors randomized 114 patients to either late or early administration of rocuronium. Eligible patients were 20+ year old ASA 1-3’s undergoing GETA for elective abdominal or gynecologic procedures. The late group received rocuronium (vs saline placebo) only after establishing mask ventilation, whereas the early group received rocuronium (vs saline placebo) with induction, prior to confirming the ability to mask ventilate. All participants were blinded.
Results: Primary outcome was the average of mask tidal volumes at 10, 20, 30, 40, 50, and 60 seconds after induction of apnea, which turned out to be 552cc for the early roc group, v 393cc for the late roc group. Furthermore, time from apnea to intubation was 116 seconds for the early roc group, v 195 seconds for the late roc group.
Strengths:
Randomized and blinded
Standardized methods to minimize provider variability
Objective measurement of mask ventilation effectiveness
Eliminated anesthetic depth as a possible confounder
Weaknesses:
Single center study
Small sample size
Excluded patients with difficult airways
Did not exclude patients with lung disease which could affect ventilation
Sample size too small to compare adverse events
Key Point: Early administration of rocuronium before checking mask ventilation resulted in larger mask tidal volumes and earlier tracheal intubation in patients with normal airways