Purpose: Succinylcholine has been the agent of choice when clinical conditions require emergency airway protection during a rapid-sequence induction of anesthesia. However, the administration of succinylcholine is not without its problems. One of its side effects is the occurrence of fasciculations. To prevent fasciculations, a nonparalyzing dose of a nondepolarizing neuromuscular-blocking drug (pretreatment) is given prior to the actual administration of succinylcholine. Atracurium is one of the most popular nondepolarizing muscle relaxants used for pretreatment. Rocuronium is a novel non depolarizing muscle relaxant, that has a promising potential as a pretreatment drug. The objective of this trial was to determine the efficacy of rocuronium as a pretreatment drug and compare it with atracurium and placebo. Methods: Sixty ASA I and II patients about to undergo an emergency operation under rapid sequence induction of general anesthesia patients were enrolled in this double blind study. They were randomly divided into 3 groups of 20 according to the nondepolarizing pretreatment to be used: 0.9 percent NaCl (control), 0.05 mg/kg atracurium and 0.06 mg/kg rocuronium. Two minutes after pretreatment, succinylcholine at 1.5 mg/kg was injected. The presence and magnitude of fasciculations and the ease of tracheal intubation were assessed. Results: There was no difference among the three groups with respect to age, sex distribution and weight. Fasciculations occurred in 42 (70 percent) out of the 60 patients: 9 (45 percent) in the rocuronium group, 13 (65 percent) in the atracurium group and 20 (100 percent) in the saline group, P0.05. The severity of fasciculations was significantly lowest in the rocuronium group, followed by the atracurium group, and was highest with the saline or control group. Intubating conditions were rated as excellent, good, fair or poor in all patients. There was no statistically significant difference among groups. Conclusion: Rocuronium is superior to atracurium in preventing and reducing the intensity of fasciculations induced by succinylcholine, with no difference in the intubating conditions. Its use therefore in rapid-sequence induction of anesthesia as pretreatment is highly recommended, because it facilitates immediate airway intubation devoid of fasciculations and its undesirable effects. (Author)
Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; FASCICULATIONS ; ROCURONIUM ; ATRACURIUM ; SUCCINYLCHOLINE ; ANESTHESIA, GENERAL ; INTUBATION

Objectives: To describe the clinical profile and factors associated with mortality among the first 200 patients confirmed to have COVID-19 infection admitted in the University of the Philippines – Philippine General Hospital (UP-PGH) Methodology: We conducted a retrospective review of adult patients with confirmed COVID-19 infection admitted in PGH, a designated COVID-19 referral center. Demographic, clinical data, and clinical outcomes were extracted from medical records. Frequencies and distributions of various clinical characteristics were described, and factors associated with mortality were investigated. Results: Of the 200 patients in our cohort, majority were male (55.5%), and more than half (58%) were over 60 years old. Underlying co-morbid illnesses (67.5%) included hypertension (49.5%), diabetes mellitus (26.5%), and cardiovascular disease (20.5%). Most frequent presenting symptoms were cough (69.0%), fever (58.5%), or shortness of breath (53.0%). Most patients presented with mild (n=41, 20.5%) to moderate illness (n=99, 49.5%) and only 60 were considered severely (n=32, 16.0%) or critically ill (n=28, 14.0%). Many (61%) received empiric antibiotics, while 44.5% received either repurposed drugs or investigational therapies for COVID-19. Bacterial co-infection was documented in 11%, with Klebsiella pneumoniae commonly isolated. In-hospital mortality was 17.5%, which was highest for critical COVID-19 (71.4%). Mortality was observed to be higher among patients age 60 and above, those requiring oxygen, ventilatory support and ICU admission, and among those who developed acute kidney injury, acute stroke, sepsis, and nosocomial pneumonia. Conclusion: Our study confirms that COVID-19 affects males, older individuals and those with underlying co-morbid conditions. Empiric antimicrobial treatment was given for majority of patients, despite documentation of bacterial infection in only 11%. K. pneumoniae was commonly isolated, reflecting local epidemiology. Mortality rate during this early period of the pandemic was high and comparable to other institutions. Factors associated with mortality were related to critical COVID-19 and are similar to other studies.
COVID-19 ; Philippines