Evaluation of Timing and Priming Principle Using Rocuronium Bromide on Intubating Conditions and Neuromuscular Blockade in Patients Undergoing General Anaesthesia

Background: Neuromuscular blocking agents are essential for facilitating endotracheal intubation and improving surgical conditions during general anaesthesia. Rocuronium, a non-depolarizing agent, is preferred due to its rapid onset and intermediate duration. Techniques such as the timing principle and priming principle are used to speed up its onset of action. This study evaluates the pharmacodynamic benefits and safety of these two administration methods.

AIM: To compare the effectiveness and rapidity of onset of rocuronium bromide for tracheal intubation using timing and priming principles in patients undergoing general anaesthesia.

Materials And Methods: This randomized double-blind study included 134 ASA I/II patients (18–60 years) undergoing elective surgery under general anaesthesia. Patients were divided into Group A (timing principle) and Group B (priming principle). Neuromuscular monitoring was done using Train-of-Four (TOF). Group B received 1/10th intubating dose of rocuronium (0.06 mg/kg) as priming, while Group A received placebo. The study evaluated time for T1 fade, intubating conditions, side effects, and hemodynamic parameters.

Results: Both groups were demographically similar. The T1 fade time was significantly shorter in the priming group (1.45 ± 0.48 min) compared to the timing group (3.30 ± 1.25 min). Intubating conditions were similar, though the response to intubation slightly favored the priming group. Hemodynamic parameters remained stable in both groups, with mild side effects (diplopia, ptosis) slightly more common in the priming group but not statistically significant.

Conclusion: The priming technique provided faster onset of neuromuscular blockade without affecting intubation quality or patient safety, making it useful in time-sensitive situations. The priming principle for administering rocuronium is a safe, effective, and efficient strategy to hasten neuromuscular blockade onset and enhance intubating conditions. Its clinical application may contribute to smoother anaesthesia induction and reduced intubation time, especially beneficial in high-risk or emergency procedures.