Comparison of Rocuronium and Vecuronium: Onset and Duration of Apnea and Desaturation Time during Intubation

Background: Rapid and reliable neuromuscular blockade is crucial for successful endotracheal intubation. Rocuronium and Vecuronium are commonly used non-depolarising neuromuscular blockers, each with unique pharmacologic properties that impact intubation conditions and patient safety.

Methods: This randomised, single-blinded clinical study was conducted after obtaining approval from the Institutional Ethical Committee. A total of 30 adult patients, aged between 18 and 60 years, classified as American Society of Anaesthesiologists (ASA) physical status I or II, scheduled for intubation under general anaesthesia, were included in the study. Patients were randomly assigned to two equal groups (n = 15 each) using a computer-generated randomisation table:

Group A : Rocuronium Group B: Vecuronium

A focused literature review was conducted, examining studies that compared Rocuronium and Vecuronium concerning onset time, duration of action, and desaturation profiles during intubation.

Results: Rocuronium demonstrated a faster onset of action (approximately 45–60 seconds) compared to Vecuronium (90–120 seconds). Both agents' duration of neuromuscular blockade was dose-dependent, with Rocuronium showing a slightly longer duration at standard intubating doses. Time to oxygen desaturation was similar for both agents when patients were adequately oxygenated. This indicates that oxygen desaturation rates are more influenced by patient-specific factors, such as baseline pulmonary function, body composition, and oxygen reserves, rather than by the choice of neuromuscular blocker.

Conclusion: Rocuronium is preferred for rapid apnea onset in intubation scenarios requiring immediate airway management. While both drugs exhibit comparable desaturation profiles with proper preoxygenation, patient physiology plays a more significant role in determining oxygen desaturation rates than the neuromuscular blocker used.