Intubating Conditions and Efficacy of Rocuronium versus Atracurium in Paediatric Patients undergoing Elective Surgeries under General Anaesthesia: A Randomised Clinical Trial

Introduction: Atracurium and rocuronium are non depolarising Neuromuscular Blockers (NMBs) with an intermediate duration of action and are used safely in the short and intermediate duration of surgical procedures in paediatric population.

Aim: To compare the efficacy and safety of NMBs (rocuronium versus atracurium) at a dose 2 x (ED95) for elective surgeries under general anaesthesia in paediatric patients.

Materials and Methods: The present randomised, double-blinded, clinical trial study was conducted in the Department of Anaesthesiology and Intensive care, Adesh Institute of Medical Science and Research (AIMSR), Bathinda, Punjab, India, from October 2021 to April 2022. Seventy American Society of Anaesthesiologists (ASA) grade I-II patients of both sexes of 1-12 years age, undergoing elective surgeries under general anaesthesia were included in the study. These patients were randomly divided into two groups: patients receiving rocuronium (0.6 mg/kg) (group R, n=35) and patients receiving atracurium (0.5 mg/kg) (group A, n=35) for endotracheal intubation. Assessments were done for timing of intubation, intubation score, interpretation of relaxogram, haemodynamics, adverse events, extubation (normal or delayed) and recovery time. All the data was entered in Microsoft excel sheet and results were expressed as percentages and mean±Standard Deviation (SD), Chi-square test and unpaired t-test.

Results: Time of intubation was faster with rocuronium than atracurium (66±20.32 vs 100.29±21.76 seconds). Intubation score was significantly lower in group A (2.14±0.36) than group R (3.74±0.44). Heart Rate (HR) increased significantly after intubation with atracurium. Adverse effects like bronchospasm, hypotension, skin reaction and wheeze were found in patients receiving atracurium but not in rocuronium group. Faster onset and recovery with short clinical duration was found with rocuronium on relaxogram. Delayed extubation was found in 45.7% patients in atracurium group and 5.7% patients in rocuronium group.

Conclusion: Rocuronium gives excellent intubating conditions with faster induction time, shorter clinical duration, high recovery index, minimal side-effects and good haemodynamic stability than atracurium in paediatric patients.