Succinylcholine vs Rocuronium

	Succinylcholine	Rocuronium
Chemical structure	Structurally two acetyl choline molecules joined together	Aminosteroid
Classification	Depolarising neuromuscular blocker	Non-depolarising neuromuscular blocker
Fasciculation	Yes ( causes post-op myalgia)	No
Metabolism	·         Rapidly metabolised by pseudocholinesterase ·         Duration of action prolonged in Pseudocholinesterase deficiency	·         Eliminated primarily by liver and slightly by kidney ·         Elimination half life longer as compared to Sch.
Dosage	·         Used for intubation only now-a-days ·         1-1.5 mg/kg iv ·         4-5 mg/kg im (onset delayed)	·         Used for both intubation as well as during maintenance ·         Intubation: 0.6-1.2mg /kg iv ·         Intubation: 1mg/kg im (infants) and 2mg/kg im (children) àonset delayed (3-6min) ·         Maintenance: 0.15 mg/kg every 20 mins ·         Continuous infusion: 5-12µg/kg/min
Onset of action after iv induction dose (onset to maximum twitch depression)	30-60secs	60-90 secs
Duration of action	3-5 mins (phase 1 block)	·         Duration of action (duration to return to ≥ 25% of control twitch height): 20-35 min ·         Clinical duration (duration to return to Train-of-four >0.9): 55-80 min
Reversal with Sugammadex	Not possible	Possible Dose: ·         4 mg/kg iv when recovery has reached 1-2 post-tetanic counts ·         2 mg/kg iv if recovery has occurred upto reappearance of T2 ·         Immediate reversal: 16 mg/kg iv (recovery of T4/T1 ratio to 0.9 by 1.5 min)
Systemic effects	·         Causes bradycardia (especially when a second dose is given after 3-8mins) ·         Hyperkalemia (increases K+ by 0.5 mEq/L) ·         Transient increase in intracranial, intraocular and intragastric pressure	·         Mostly cardiostable ·         Mild vagolytic
Malignant hyperthermia risk	Yes	No
Use in burn patients	Avoid beyond 2 days till 2 yrs after burn (risk of hyperkalemia)	Can be used safely
Apnoea time (time available until critical desaturation occurs in the absence of ventilation after administration of the drug)	Less (because of fasciculation which uses up oxygen)	More
Paediatric usage	Usually avoided especially in case of unknown/undiagnosed myopathy	Can be used safely
Shelf life	Stable at room temperature for upto 14 days	Stable at room temperature for upto 12 weeks

Awake Intubation (procedure in brief)