BACKGROUND: Rocuronium for cesarean delivery under general anesthesia is an alternative to succinylcholine for rapid-sequence induction of anesthesia because of the availability of sugammadex for reversal of neuromuscular blockade. However, there are no large well-controlled studies in women undergoing general anesthesia for cesarean delivery. The aim of this noninferiority trial was to determine whether rocuronium and sugammadex confer benefit in time to tracheal intubation (primary outcome) and other neuromuscular blockade outcomes compared with succinylcholine, rocuronium, and neostigmine in women undergoing general anesthesia for cesarean delivery. METHODS: We aimed to enroll all women undergoing general anesthesia for cesarean delivery in the 2 participating university hospitals (Brno, Olomouc, Czech Republic) in this single-blinded, randomized, controlled study. Women were randomly assigned to the ROC group (muscle relaxation induced with rocuronium 1 mg/kg and reversed with sugammadex 2-4 mg/kg) or the SUX group (succinylcholine 1 mg/kg for induction, rocuronium 0.3 mg/kg for maintenance, and neostigmine 0.03 mg/kg for reversal of the neuromuscular blockade). The interval from the end of propofol administration to tracheal intubation was the primary end point with a noninferiority margin of 20 seconds. We recorded intubating conditions (modified Viby-Mogensen score), neonatal outcome (Apgar score <7; umbilical artery pH), anesthesia complications, and subjective patient complaints 24 hours after surgery. RESULTS: We enrolled 240 parturients. The mean time to tracheal intubation was 2.9 seconds longer in the ROC group (95% confidence interval, -5.3 to 11.2 seconds), noninferior compared with the SUX group. Absence of laryngoscopy resistance was greater in the ROC than in the SUX groups (ROC, 87.5%; SUX, 74.2%; P = 0.019), but there were no differences in vocal cord position (P = 0.45) or intubation response (P = 0.31) between groups. No statistically significant differences in incidence of anesthesia complications or in neonatal outcome were found (10-minute Apgar score <7, P = 0.07; umbilical artery pH, P = 0.43). The incidence of postpartum myalgia was greater in the SUX group (ROC 0%; SUX 6.7%; P = 0.007). The incidence of subjective complaints was lower in the ROC group (ROC, 21.4%; SUX, 37.5%; P = 0.007). CONCLUSIONS: We conclude that rocuronium for rapid-sequence induction is noninferior for time to tracheal intubation and is accompanied by more frequent absence of laryngoscopy resistance and lower incidence of myalgia in comparison with succinylcholine for cesarean delivery under general anesthesia.

• MeSH
• androstanoly aplikace a dávkování   škodlivé účinky   MeSH
• antidota aplikace a dávkování   škodlivé účinky   MeSH
• časové faktory MeSH
• celková anestezie * škodlivé účinky   MeSH
• cholinesterasové inhibitory aplikace a dávkování   škodlivé účinky   MeSH
• císařský řez * škodlivé účinky   MeSH
• dospělí MeSH
• gama-cyklodextriny aplikace a dávkování   škodlivé účinky   MeSH
• intratracheální intubace MeSH
• jednoduchá slepá metoda MeSH
• laryngoskopie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• myalgie etiologie   prevence a kontrola   MeSH
• neostigmin aplikace a dávkování   škodlivé účinky   MeSH
• nervosvalová blokáda škodlivé účinky   metody   MeSH
• nervosvalové látky nedepolarizující aplikace a dávkování   škodlivé účinky   MeSH
• pooperační bolest etiologie   prevence a kontrola   MeSH
• porodnická anestezie škodlivé účinky   metody   MeSH
• rokuronium MeSH
• sugammadex MeSH
• sukcinylcholin aplikace a dávkování   MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• androstanoly MeSH
• antidota MeSH
• cholinesterasové inhibitory MeSH
• gama-cyklodextriny MeSH
• neostigmin MeSH
• nervosvalové látky nedepolarizující MeSH
• rokuronium MeSH
• sugammadex MeSH
• sukcinylcholin MeSH