Background. We evaluated the pharmacodynamic interaction of the combination of pancuronium and Rocuronium by analyzing time-response relationship, quality of intubating conditions, changes in the hemodynamics, and cost effectiveness as compared to individual drugs. Methods. Sixty patients in the ASA-I category received either 10？ml of 0.9？mg/kg rocuronium (R) plus 10？ml of saline or 10？ml of 0.1？mg/kg pancuronium (P) plus 10？ml of saline or a combination (C) of 10？ml of 0.45？mg/kg R plus 10？ml of 0.05？mg/kg P according to randomization list. Neuromuscular function was measured up to maximal suppression of twitch height. Results. The mean times (sec) taken for twitch height to decrease to 50% of baseline in R, P, and C were , , and , respectively. The mean cost of intubation per patient was INR in group R, INR in group P, and INR in group C. Conclusions. The combination of P and R provides rapid and smooth intubation with minimal hemodynamic changes at a reasonably priced cost. 1. Introduction Over the last few decades the focus of research has been on the development of muscle relaxants with a short onset of action that can be used for rapid sequence intubation. It has been shown that speed of onset is inversely related to molar potency [1, 2]. The major disadvantage of use of less potent drugs is pharmacoeconomics burden of intubation [3, 4]. So far, it has been very difficult to find the optimal compromise between potency and rapid onset of action. The pharmacokinetic options to achieve rapid onset of action are use of supramaximal doses, priming, and cocktails of relaxants. Many experimental combinations of amino steroid relaxants and benzo-isoquinolinium relaxants failed to demonstrate either synergism or pharmacoeconomics advantage [5]. Pancuronium is one of the most potent and least expensive nondepolarizing neuromuscular blocking drugs available. However, its onset of action is slow. Pancuronium has predominant postsynaptic mechanism of action, whereas rocuronium, a monoquaternary analogue of Pancuronium has a predominant presynaptic action [6]. It has been hypothesized that combination of these drugs with different pharmacodynamic characteristics might confer advantage of synergism resulting in rapid onset of action at a lesser cost. To this purpose we evaluated the pharmacodynamic interaction by analyzing time-response relationship, quality of intubating conditions, changes in the hemodynamics, and cost effectiveness of the combination of rocuronium and pancuronium as compared to individual drugs when given alone. 2. Methods According to
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