Comparison of Cerebral Blood Flow Velocities by Transcranial Doppler during Anesthetic Induction: Rocuronium and Succinylcholine

Cheong, Soon Ho; Kim, Young Whan; Kim, Seo Yong; Lee, Kun Moo; Choe, Young Kyun; Kim, Young Jae; Park, Jin Woo; Shin, Chee Mahn; Park, Ju Yuel

Abstract

BACKGROUND: In intravenous administration of a depolarizing neuromuscular blocker, succinylcholine is reported to produce activation of the electroencephalogram and increase cerebral blood flow and intracranial pressure. In this point, rocuronium was recently introduced as a non-depolarizing relaxant, and recommended as a safe alternative to succinylcholine. The purpose of this study was to evaluate the effects of rocuronium and succinylcholine on cerebral blood flow velocities during anesthetic induction.
METHODS
Forty patients were randomly assigned into two groups. Group 1 was administrated rocuronium 0.6 mg/kg and group 2 was administrated succinylcholine 1 mg/kg for tracheal intubation after each group had intravenous administration of thiopental 5 mg/kg. The author observed changes of mean arterial pressure, arterial carbon dioxide tension, and middle cerebral arterial blood flow velocities at 5 times: before induction (control), 30 sec after thiopental administration, 30 sec, 60 sec and 90 sec after muscle relaxant administration.
RESULTS
Mean arterial pressure decreased more at 30 sec after thiopental administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30 sec after thiopental administration and 60 sec after rocuronium administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30, 60, 90 sec after rocuronium administration compared with succinylcholine administration (P<0.05).
CONCLUSIONS
We conclude that rocuronium has little effects on increasing cerebral blood flow. These result suggest that rocuronium have a less effect on increase in cerebral blood flow during neurosurgical anesthesia.