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Vecuronium for Rapid‐Sequence Intubation for Cesarean Section

Because succinylcholine may occasionally be contraindicated for rapid-sequence induction in parturients, we studied the use of vecuronium in 21 patients having elective cesarean sections. Eleven patients (group 1) received 10 μg/kg vecuronium as a priming dose, followed 4–6 min later by 100 μg/kg. Ten patients (group 2) received 200 μg/kg vecuronium as a bolus. Onset, the time from the injection of vecuronium to maximal twitch suppression, and clinical duration, the time between vecuronium administration and return to 25% of the control twitch height, were recorded. Umbilical and maternal venous blood samples at delivery were analyzed for vecuronium concentrations. One-minute and 5-min Apgar scores and 1− and 24-h Neurologic and Adaptive Capacity Scores (NACS) were recorded. Individual tests of passive and active tone within the overall NACS profile were compared to evaluate further any residual vecuronium effects in the infants. Onset of neuromuscular blockade was 177 s in group 1 and 175 s in group 2. The corresponding clinical durations were 73 and 115 min. Maternal and umbilical venous vecuronium concentrations were 515 and 73 ng/mL in group 1 and 838 and 107 ng/mL in group 2. Seventy percent of neonates in group 1 had Apgar scores greater than 7 at 1 min, with 100% greater than 7 at 5 min. Corresponding values in group 2 infants were 50% and 80%. Fifty percent of group 1 infants had NACS of 35–40 at 1 h, and 70% at 24 h. Corresponding values in group 2 infants were 50% and 80%. These data suggest that the priming dose regimen for vecuronium administration may be a useful alternative for rapid-sequence induction for cesarean section when succinylcholine is contraindicated. However, the onset and clinical duration were longer than desired, and the NACS data suggested residual effects in the infants.