A 26-year-old man with a depressed skull fracture and GCS 13 requires emergency anaesthesia for wound exploration. He has no features of raised intracranial pressure. Which neuromuscular blocking strategy is MOST appropriate for rapid sequence induction?

• A Succinylcholine 1.5 mg/kg preceded by a defasciculating dose of rocuronium
• B Vecuronium 0.15 mg/kg followed by cricoid pressure
• C Succinylcholine 1.5 mg/kg alone
• D Rocuronium 1.2 mg/kg alone ✓

Explanation

Rocuronium 1.2 mg/kg provides intubating conditions comparable to succinylcholine within 60 seconds without any increase in intracranial pressure. Succinylcholine raises ICP by roughly 5 to 10 mmHg for several minutes through fasciculation-induced cerebral activation, so it is avoided in head injury whenever a suitable alternative exists. Vecuronium is too slow for rapid sequence induction at this dose.

Reference: Miller's Anesthesia, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.