Comparative Evaluation of Effectiveness of Rocuronium Bromide vs. Succinyl Choline on Quality of Intubating Conditions during General Anesthesia

Aditi Burkul, Nazima Memon, Vaishnavi Kulkarni


Objectives: To compare the quality of intubating conditions and hemodynamic responses to the administration of Rocuronium Bromide and Succinyl Choline during general anesthesia.

Methods: This was a comparative study conducted at the anesthesiology department of a tertiary care medical college. Sixty patients undergoing various surgeries under general anesthesia were included in this study based on predefined inclusion and exclusion criteria. Patients were divided into Group S (receiving succinylcholine) and Group R (receiving rocuronium). In all patients, the quality of intubating conditions was assessed. Excellent or good conditions were considered to be acceptable intubating conditions, whereas fair and poor conditions were considered unacceptable.

Results: Mean age, weight, gender distribution, and ASA grades were comparable in both groups. The overall quality of intubation was found to be better in group S than in group R, and the difference was statistically significant (P=0.004). The duration of action was significantly longer in group R than in group S (P<0.001). Hemodynamic stability was comparable in both the groups, except for heart rate at 10 min, which was higher in Group R than in Group S. Incidence of fasciculation was significantly more in Group S as compared to Group R, and the difference was found to be highly significant (P=0.0001).

Conclusion: Succinylcholine for rapid sequence intubation is associated with better intubation conditions than rocuronium.


Intubation; Muscle Relaxants; Rucuronium; Succinylcholine

Full Text:



  1. Spirova EN, Ivanov IA, Kasheverov IE, et al. Curare alkaloids from Matis Dart Poison: Comparison with d-tubocurarine in interactions with nicotinic, 5-HT3 serotonin and GABAA receptors. PLoS One. 2019; 14(1):e0210182. doi:10.1371/journal.pone.0210182.
  2. Bhat R, Sanickop CS, Patil MC, Umrani VS, Dhorigol MG. Comparison of Macintosh laryngoscope and C-MAC video laryngoscope for intubation in lateral position. J Anaesthesiol Clin Pharmacol. 2015;31(2):226–9.doi:10.4103/0970-9185.155221.
  3. Patel S, Shukla J, Jain S, Paliwal V, Tripathi N, Paliwal S, et al. Repositioning of tubocurarine as analgesic and anti-inflammatory agent: Exploring beyond myorelaxant activity. Biochem Pharmacol. 2022;205:115248. doi:10.1016/j.bcp.2022. 115248
  4. Martini CH, Honing GHM, Bash LD, Olofsen E, Niesters M, van Velzen M, et al. The use of muscle relaxants and reversal agents in a setting without cost restrictions: experience from a Tertiary Academic Hospital in the Netherlands. Ther Clin Risk Manag. 2022;18:379-90. doi:10.2147/TCRM.S350314.
  5. Bohringer C, Moua H, Liu H. Is there still a role for succinylcholine in contemporary clinical practice?. Transl Perioper Pain Med. 2019; 6(4):129-35. doi:10.31480/2330-4871/100
  6. Luxen J, Trentzsch H, Urban B. Rocuronium und Sugammadex in der Notfallmedizin: Anforderungen an ein Muskelrelaxans für die “rapid sequence induction” [Rocuronium and sugammadex in emergency medicine: requirements of a muscle relaxant for rapid sequence induction]. Anaesthesist. 2014; 63(4):331–7. doi:10.1007/s00101-014-2303-1
  7. Mørk EL, Kristensen ML, Stokholm JB, Söderström CM, Madsen MV, Gätke MR. Resistance towards nondepolarising muscle relaxants: prolonged onset time: A systematic review. Eur J Anaesthesiol. 2019; 36(7):477–85. doi:10.1097/EJA.0000000000000991
  8. Tachikawa M, Asai T, Okuda Y. Rocuronium bromide intravenous solution maruishi is more suitable than ESLAX intravenous during rapid-sequence induction of anesthesia. J Anesth. 2019; 33(5):600–3. doi: 10.1007/s00540-019-02673-x.
  9. Cooper R, Mirakhur RK, Clarke RS, Boules Z. Comparison of intubating conditions after administration of Org 9246 (rocuronium) and suxamethonium. Br J Anaesth. 1992; 69(3):269–73. doi:10.1093/bja/69.3.269
  10. Yuan H, Zhang S, Yin L, Luo T, Zhang R, Wu S. The safety of high-dose rocuronium bromide in general anesthesia for spinal surgery and its effects on muscle relaxation. Am J Transl Res. 2021;13(7):8110–7.
  11. Tran DT, Newton EK, Mount VA, Lee JS, Wells GA, Perry JJ. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2015;2015(10):CD002788. doi:10.1002/14651858.CD002788.pub3
  12. Guihard B, Chollet-Xémard C, Lakhnati P, Vivien B, Broche C, Savary D, et al. Effect of rocuronium vs succinylcholine on endotracheal intubation success rate among patients undergoing out-of-hospital rapid sequence intubation: a randomized clinical trial. JAMA. 2019; 322(23):2303–12. doi:10.1001/jama. 2019.18254
  13. Chavan SG, Gangadharan S, Gopakumar AK. Comparison of rocuronium at two different doses and succinylcholine for endotracheal intubation in adult patients for elective surgeries. Saudi J Anaesth. 2016; 10(4):379–83. doi:10.4103/1658-354X.177330
  14. Magorian T, Flannery KB, Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology. 1993;79(5):913–18. doi:10.1097/00000542-199311000-00007
  15. Li G, Cheng L, Wang J. Comparison of rocuronium with succinylcholine for rapid sequence induction intubation in the Emergency Department: a retrospective study at a Single Center in China. Med Sci Monit. 2021;27:e928462. doi:10.12659/MSM.928462
  16. Wilson JW, Gillen JP, Maute T. Patient safety during rapid sequence intubation when using succinylcholine instead of nondepolarizing paralytic agents: should we change a common rapid sequence intubation pathway?. J Emerg Trauma Shock. 2020;13(4):264–68. doi:10.4103/JETS.JETS_92_18
  17. Lenin P, Rajaraman R, Stalin R, Manikandan G. A comparative study between rocuronium and succinylcholine in evaluating endotracheal intubating conditions in day care surgeries. IAIM, 2022;9(1): 34–9.
  18. Marsch SC, Steiner L, Bucher E, Pargger H, Schumann M, Aebi T, et al. Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial. Crit Care. 2011;15(4):R199. doi:10.1186/cc10367
  19. Sørensen MK, Bretlau C, Gätke MR, Sørensen AM, Rasmussen LS. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. Br J Anaesth. 2012;108(4):682–9. doi:10.1093/bja/aer503
  20. Zhang Z, Zhang DS, Sui W, Liu XH, Zhang L, Sun JH. Effects of pretreatment with different doses of cisatracurium on succinylcholine-induced fasciculations. Int J Clin Pharmacol Ther. 2016;54(6):426–32. doi:10.5414/CP202531


Article Metrics

Abstract view : 253 times
PDF - 130 times


This Journal indexed by



Creative Commons License
IJIHS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

View My Stats