Comparison of the intubation conditions provided by rapacuronium (ORG 9487) or succinylcholine in humans during anesthesia with fentanyl and propofol

Anesthesiology. 1999 Nov;91(5):1311-7. doi: 10.1097/00000542-199911000-00023.


Background: Currently, the only approved muscle relaxant with a rapid onset and short duration of action is succinylcholine, a drug with some undesirable effects. Rapacuronium is an investigational nondepolarizing relaxant that also has a rapid onset and short duration and consequently should be compared with succinylcholine in its ability to facilitate rapid tracheal intubation.

Methods: This prospective, randomized clinical trial involved 336 patients. Anesthesia was induced with fentanyl and propofol and either 1.5 mg/kg rapacuronium or 1.0 mg/kg succinylcholine. The goal was to accomplish tracheal intubation by 60 s after administration of the neuromuscular blocking drug. Endotracheal intubation was performed, and conditions were graded by a blinded investigator. Recovery of neuromuscular function was assessed by electromyography.

Results: Intubation conditions were evaluated in 236 patients. Intubation by 60 s after drug administration occurred in 100% of patients with rapacuronium and in 98% with succinylcholine. Intubation conditions were excellent or good in 87% of patients with rapacuronium and in 95% with succinylcholine (P < 0.05). The time (median and range) to the first recovery of the train-of-four response was 8.0 (2.8-20.0) min with rapacuronium and 5.7 (1.8-17.7) min with succinylcholine (P < 0.05). The overall incidence of adverse effects was similar with both drugs.

Conclusions: A 1.5-mg/kg dose of rapacuronium effectively facilitates rapid tracheal intubation. It can be considered a valid alternative to 1.0 mg/kg succinylcholine for this purpose.

Publication types

  • Clinical Trial
  • Clinical Trial, Phase III
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aging / physiology
  • Anesthetics, Combined* / adverse effects
  • Anesthetics, Intravenous*
  • Blood Pressure / drug effects
  • Female
  • Fentanyl*
  • Heart Rate / drug effects
  • Humans
  • Intubation, Intratracheal*
  • Male
  • Middle Aged
  • Neuromuscular Blocking Agents* / adverse effects
  • Propofol*
  • Prospective Studies
  • Succinylcholine* / adverse effects
  • Vecuronium Bromide / adverse effects
  • Vecuronium Bromide / analogs & derivatives*


  • Anesthetics, Combined
  • Anesthetics, Intravenous
  • Neuromuscular Blocking Agents
  • Vecuronium Bromide
  • rapacuronium
  • Succinylcholine
  • Fentanyl
  • Propofol