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Einfluss des Geschlechts auf die Intubationsbedingungen nach Rocuronium

Influence of gender on the intubation conditions with rocuronium

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Zusammenfassung

Fragestellung

Die pharmakodynamische Wirkung zahlreicher Anästhetika und Muskelrelaxanzien, u. a. Rocuronium (Roc), wird auch durch das Geschlecht der Patienten beeinflusst. Frauen haben eine um ca. 30% erhöhte Sensitivität (verkürzte Anschlagzeit und tiefere neuromuskuläre Blockade) gegenüber Roc als Männer. Ob damit auch eine Verbesserung der Intubationsbedingungen einhergeht, ist unklar.

Methodik

Nach Zustimmung der Ethikkommission wurden 60 Frauen und 60 Männer jeweils in 2 Gruppen randomisiert, um 0,6 mg/kgKG Roc oder 1,0 mg/kgKG Succinylcholin (Sux; Kontrollgruppen) zu erhalten. Narkoseeinleitung: Fentanyl (3 µg/kgKG), Thiopental (5,0 mg/kgKG) und Roc/Sux; endotracheale Intubation: 60 s später. Bestimmt wurden Anzahl der Intubationsversuche, Intubationszeit, Larynxbefund nach Cormack u. Lehane sowie Intubationsbedingungen („Kopenhagener score“).

Ergebnisse

Männer waren signifikant schwerer und größer (p<0,001); der Bodymass-Index (BMI) war vergleichbar. Intubationszeiten und Cormack-Grade waren vergleichbar. Bei den weiblichen Patienten traten akzeptable (exzellente und gute) Intubationsbedingungen nach Roc signifikant häufiger als bei den männlichen auf (80% vs. 47%, p<0,05).

Schlussfolgerungen

Klinisch akzeptable Intubationsbedingungen nach Roc waren bei Frauen signifikant häufiger. Dieser geschlechtsspezifische Unterschied war Roc-bezogen; in den Kontrollgruppen trat er nicht auf. So wurden 80% an klinisch akzeptablen Intubationsbedingungen nach Roc bei den Frauen erreicht; dies war identisch mit der Sux-Gruppe.

Abstract

Purpose

There is increasing evidence for gender differences in the pharmacokinetics and pharmacodynamics of anaesthetic drugs and neuromuscular blocking agents, e.g. rocuronium (Roc). Females require 30% less Roc than males to achieve the same degree of neuromuscular block and onset times are shorter. However, whether this leads to an improvement of the intubation conditions in females is unclear.

Methods

After approval of the ethics committee 60 female and 60 male patients were each randomised into 2 groups to receive 0.6 mg/kg body weight Roc or 1.0 mg/kg succinylcholine (Sux; control group). Induction: thiopentone (5 mg/kg), fentanyl (3µg/kg) then Roc (Roc groups) or Sux (Sux groups) and tracheal intubation after 60 s. Time to intubation, glottic exposure and intubating conditions were assessed.

Results

Men were significantly larger and heavier (p<0.001) than women, but the body mass index was comparable (ns). Number of attempts, time to intubation, and Cormack grades were comparable (ns). However, the rate of clinically acceptable intubation conditions was significantly higher in the female compared to the male Roc group: 80% vs 47%, p<0.05. The incidence of clinically acceptable intubation conditions in the female Roc and Sux groups were similar (80%).

Conclusion

The intubation conditions after Roc were significantly better in women than in men. The differences were Roc-related and did not occur in the control groups.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Rostock, Rostock

    T. Mencke

  2. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar

    J-U. Schreiber, H. Knoll, M. Werth, U. Grundmann & H. Rensing

  3. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Rostock, Schillingallee 35, 18057, Rostock

    T. Mencke

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  1. T. Mencke
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  2. J-U. Schreiber
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  3. H. Knoll
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  4. M. Werth
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  5. U. Grundmann
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  6. H. Rensing
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Correspondence to T. Mencke.

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Mencke, T., Schreiber, JU., Knoll, H. et al. Einfluss des Geschlechts auf die Intubationsbedingungen nach Rocuronium. Anaesthesist 54, 884–888 (2005). https://doi.org/10.1007/s00101-005-0890-6

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  • DOI: https://doi.org/10.1007/s00101-005-0890-6

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