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Rocuronium versus Cisatracurium for Rapid Sequence Induction of Anesthesia in Morbidly Obese Patients

Introduction and Aim: Obesity is a challenging problem for anesthetists. Difficult airway with risk of aspiration and regurgitation increases with obesity. Therefore, the need for effective and safe drug for rapid induction of anesthesia is crucial to ensure fast good intubation condition. The aim of this study is to assess Rocuronium versus Cisatracurium for rapid sequence induction of anesthesia in morbidly obese patients. 
Patients and methods: This study included 60 patients with ASA physical status II, aged 21-40 years, BMI 35-40 kg/m2 and scheduled for elective surgery under general anesthesia. Patients were classified into two equal groups: Group (R): received Rocuronium bromide (Esmeron) in a dose of 0.9 mg/kg (lean body mass) for intubation; Group (C): received Cisatracurium besylate (Nimbex) in a dose of 0.15 mg/kg (LBM) for intubation. Timing of intubation in seconds, intubation score (excellent, good, poor, or inadequate), and hemodynamic variables before induction (baseline), after induction and before injection of Neuro-muscular blocker (NMB), after injection of NMB and before endotracheal intubation and just after intubation were assessed and measured. 
Results: There was statistically significant decrease in the timing of intubation in R group (84.0 ± 18.50) as compared to C group (96.0 ± 13.29). However, there was no statistically significant difference in the intubation score among the two groups. There was significant decrease in heart rate and mean arterial blood pressure after the induction of anaesthesia as compared to the baseline in both groups; Heart rate and mean arterial blood pressure changes were comparable among the two groups all of the time. 
Conclusion: Rocuronium for rapid sequence induction in morbidly obese patients is associated with faster onset compared with cisatracurium, with comparable intubation condition and hemodynamic variables. We recommend further studies to be conducted for evaluation of both drugs with different doses.