A 45-year-old man with a large frontal glioma and CT evidence of midline shift requires rapid sequence induction for emergency craniotomy. Which neuromuscular blocking drug is MOST appropriate to facilitate intubation in this patient?
- A Succinylcholine
- B Rocuronium ✓
- C Atracurium
- D Vecuronium
Correct answer: B. Rocuronium
Explanation
Succinylcholine produces a transient rise in ICP through fasciculation-induced increases in cerebral metabolic rate and muscle spindle afferent discharge, so it is avoided when intracranial hypertension is present. Rocuronium at 1.2 mg/kg provides intubating conditions comparable to succinylcholine within about 60 seconds without increasing ICP, making it the standard alternative for rapid sequence induction in neurosurgical patients. Vecuronium and atracurium have slower onsets unsuitable for rapid sequence induction.
Reference: Morgan and Mikhail's Clinical Anesthesiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.