Remifentanil Versus Rocuronium for Optimising Video Laryngoscopy Assisted Tracheal Intubation-The ROCVIDEO Trial Protocol

Emil Ørskov Ipsen; Lars Hyldborg Lundstrøm; Åse Lodenius; Gustav Fisker; Magnus Fuhr Hovind; Christian Lindgren Nielsen; Hrund Oskarsdottir; Camilla Strøm; Charlotte Vallentin Rosenstock; Karl Peter Damgård Madsen; Sine Wichmann; Arash Afshari; Jacob Hessel Andersen; Helene Korvenius Nedergaard; Louise Bill; Maria Cronhjort; Ole Mathiesen; Janus Christian Jakobsen; Matias Vested; Anders Kehlet Nørskov

doi:10.1111/aas.70277

Remifentanil Versus Rocuronium for Optimising Video Laryngoscopy Assisted Tracheal Intubation-The ROCVIDEO Trial Protocol

Emil Ørskov Ipsen^*, Lars Hyldborg Lundstrøm, Åse Lodenius, Gustav Fisker, Magnus Fuhr Hovind, Christian Lindgren Nielsen, Hrund Oskarsdottir, Camilla Strøm, Charlotte Vallentin Rosenstock, Karl Peter Damgård Madsen, Sine Wichmann, Arash Afshari, Jacob Hessel Andersen, Helene Korvenius Nedergaard, Louise Bill, Maria Cronhjort, Ole Mathiesen, Janus Christian Jakobsen, Matias Vested, Anders Kehlet Nørskov

^*Corresponding author for this work

Abstract

BACKGROUND: Routine use of neuromuscular blocking agents (NMBAs) is widely recommended to facilitate tracheal intubation. However, NMBA use is associated with potential adverse effects, including postoperative respiratory complications, intraoperative awareness and anaphylaxis. Bolus remifentanil is an alternative, but evidence supporting its effectiveness on first-pass success when using video laryngoscopy is sparse. We hypothesise that rocuronium reduces failed first-pass and the risk of induction- or airway-management-related complications compared with bolus remifentanil when using a video laryngoscope.

METHODS: ROCVIDEO is a Danish-Swedish, blinded, randomised, controlled trial comparing rocuronium (0.6 mg/kg) with remifentanil (4 μg/kg) at anaesthesia induction for facilitating orotracheal intubation using video laryngoscopy. Eligible adult participants (ASA-class I-III) undergoing general anaesthesia with video laryngoscopy-assisted orotracheal intubation will be randomised to rocuronium or remifentanil in a ratio of 1:1. Anaesthesia will be induced with propofol and optional fentanyl or sufentanil. Intubation will be initiated 120 s after administration of trial medicine. The two co-primary outcomes are: (I) anaesthesia-related adverse events and (II) failed first-pass intubation. Secondary outcomes include patient satisfaction, length of stay in the post anaesthesia care unit and serious adverse events. The trial will randomise 2684 participants to be able to detect a 30% relative risk reduction in failed first pass intubation and anaesthesia-related adverse events, with corresponding power of 80% and 99%, respectively, using a two-sided α of 0.025.

PERSPECTIVES: Given the global volume of tracheal intubation, even small differences may have substantial clinical implications. ROCVIDEO will generate high-quality evidence to inform future guidelines aiming to improve global clinical practice.

STATUS: As of 15 June 2026, the trial has randomised 707 participants across 15 sites. Recruitment is expected to be completed in the third quarter of 2027.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT06564857; EUClinicalTrials.eu: 2025-521405-40-01.

Original language	English
Article number	e70277
Journal	Acta Anaesthesiologica Scandinavica
Volume	70
Issue number	6
Pages (from-to)	e70277
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.70277
Publication status	Published - Jul 2026

Keywords

Humans
Remifentanil
Rocuronium
Intubation, Intratracheal/methods
Laryngoscopy/methods
Adult
Randomized Controlled Trials as Topic
Female
Video-Assisted Techniques and Procedures
Anesthesia, General
Neuromuscular Nondepolarizing Agents
Male

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Ipsen, E. Ø., Lundstrøm, L. H., Lodenius, Å., Fisker, G., Hovind, M. F., Nielsen, C. L., Oskarsdottir, H., Strøm, C., Rosenstock, C. V., Madsen, K. P. D., Wichmann, S., Afshari, A., Andersen, J. H., Nedergaard, H. K., Bill, L., Cronhjort, M., Mathiesen, O., Jakobsen, J. C., Vested, M., & Nørskov, A. K. (2026). Remifentanil Versus Rocuronium for Optimising Video Laryngoscopy Assisted Tracheal Intubation-The ROCVIDEO Trial Protocol. Acta Anaesthesiologica Scandinavica, 70(6), e70277. Article e70277. https://doi.org/10.1111/aas.70277

Ipsen, EØ , Lundstrøm, LH, Lodenius, Å, Fisker, G , Hovind, MF , Nielsen, CL , Oskarsdottir, H , Strøm, C , Rosenstock, CV , Madsen, KPD , Wichmann, S , Afshari, A, Andersen, JH, Nedergaard, HK, Bill, L, Cronhjort, M, Mathiesen, O, Jakobsen, JC , Vested, M & Nørskov, AK 2026, 'Remifentanil Versus Rocuronium for Optimising Video Laryngoscopy Assisted Tracheal Intubation-The ROCVIDEO Trial Protocol', Acta Anaesthesiologica Scandinavica, vol. 70, no. 6, e70277, pp. e70277. https://doi.org/10.1111/aas.70277

@article{68d6d95ff0504b06aae12eabd40ff71b,

title = "Remifentanil Versus Rocuronium for Optimising Video Laryngoscopy Assisted Tracheal Intubation-The ROCVIDEO Trial Protocol",

abstract = "BACKGROUND: Routine use of neuromuscular blocking agents (NMBAs) is widely recommended to facilitate tracheal intubation. However, NMBA use is associated with potential adverse effects, including postoperative respiratory complications, intraoperative awareness and anaphylaxis. Bolus remifentanil is an alternative, but evidence supporting its effectiveness on first-pass success when using video laryngoscopy is sparse. We hypothesise that rocuronium reduces failed first-pass and the risk of induction- or airway-management-related complications compared with bolus remifentanil when using a video laryngoscope.METHODS: ROCVIDEO is a Danish-Swedish, blinded, randomised, controlled trial comparing rocuronium (0.6 mg/kg) with remifentanil (4 μg/kg) at anaesthesia induction for facilitating orotracheal intubation using video laryngoscopy. Eligible adult participants (ASA-class I-III) undergoing general anaesthesia with video laryngoscopy-assisted orotracheal intubation will be randomised to rocuronium or remifentanil in a ratio of 1:1. Anaesthesia will be induced with propofol and optional fentanyl or sufentanil. Intubation will be initiated 120 s after administration of trial medicine. The two co-primary outcomes are: (I) anaesthesia-related adverse events and (II) failed first-pass intubation. Secondary outcomes include patient satisfaction, length of stay in the post anaesthesia care unit and serious adverse events. The trial will randomise 2684 participants to be able to detect a 30\% relative risk reduction in failed first pass intubation and anaesthesia-related adverse events, with corresponding power of 80\% and 99\%, respectively, using a two-sided α of 0.025.PERSPECTIVES: Given the global volume of tracheal intubation, even small differences may have substantial clinical implications. ROCVIDEO will generate high-quality evidence to inform future guidelines aiming to improve global clinical practice.STATUS: As of 15 June 2026, the trial has randomised 707 participants across 15 sites. Recruitment is expected to be completed in the third quarter of 2027.TRIAL REGISTRATION: ClinicalTrials.gov: NCT06564857; EUClinicalTrials.eu: 2025-521405-40-01.",

keywords = "Humans, Remifentanil, Rocuronium, Intubation, Intratracheal/methods, Laryngoscopy/methods, Adult, Randomized Controlled Trials as Topic, Female, Video-Assisted Techniques and Procedures, Anesthesia, General, Neuromuscular Nondepolarizing Agents, Male",

author = "Ipsen, \{Emil {\O}rskov\} and Lundstr{\o}m, \{Lars Hyldborg\} and {\AA}se Lodenius and Gustav Fisker and Hovind, \{Magnus Fuhr\} and Nielsen, \{Christian Lindgren\} and Hrund Oskarsdottir and Camilla Str{\o}m and Rosenstock, \{Charlotte Vallentin\} and Madsen, \{Karl Peter Damg{\aa}rd\} and Sine Wichmann and Arash Afshari and Andersen, \{Jacob Hessel\} and Nedergaard, \{Helene Korvenius\} and Louise Bill and Maria Cronhjort and Ole Mathiesen and Jakobsen, \{Janus Christian\} and Matias Vested and N{\o}rskov, \{Anders Kehlet\}",

note = "{\textcopyright} 2026 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley \& Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.",

year = "2026",

month = jul,

doi = "10.1111/aas.70277",

language = "English",

volume = "70",

pages = "e70277",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

publisher = "Blackwell Munksgaard",

number = "6",

}

TY - JOUR

T1 - Remifentanil Versus Rocuronium for Optimising Video Laryngoscopy Assisted Tracheal Intubation-The ROCVIDEO Trial Protocol

AU - Ipsen, Emil Ørskov

AU - Lundstrøm, Lars Hyldborg

AU - Lodenius, Åse

AU - Fisker, Gustav

AU - Hovind, Magnus Fuhr

AU - Nielsen, Christian Lindgren

AU - Oskarsdottir, Hrund

AU - Strøm, Camilla

AU - Rosenstock, Charlotte Vallentin

AU - Madsen, Karl Peter Damgård

AU - Wichmann, Sine

AU - Afshari, Arash

AU - Andersen, Jacob Hessel

AU - Nedergaard, Helene Korvenius

AU - Bill, Louise

AU - Cronhjort, Maria

AU - Mathiesen, Ole

AU - Jakobsen, Janus Christian

AU - Vested, Matias

AU - Nørskov, Anders Kehlet

PY - 2026/7

Y1 - 2026/7

N2 - BACKGROUND: Routine use of neuromuscular blocking agents (NMBAs) is widely recommended to facilitate tracheal intubation. However, NMBA use is associated with potential adverse effects, including postoperative respiratory complications, intraoperative awareness and anaphylaxis. Bolus remifentanil is an alternative, but evidence supporting its effectiveness on first-pass success when using video laryngoscopy is sparse. We hypothesise that rocuronium reduces failed first-pass and the risk of induction- or airway-management-related complications compared with bolus remifentanil when using a video laryngoscope.METHODS: ROCVIDEO is a Danish-Swedish, blinded, randomised, controlled trial comparing rocuronium (0.6 mg/kg) with remifentanil (4 μg/kg) at anaesthesia induction for facilitating orotracheal intubation using video laryngoscopy. Eligible adult participants (ASA-class I-III) undergoing general anaesthesia with video laryngoscopy-assisted orotracheal intubation will be randomised to rocuronium or remifentanil in a ratio of 1:1. Anaesthesia will be induced with propofol and optional fentanyl or sufentanil. Intubation will be initiated 120 s after administration of trial medicine. The two co-primary outcomes are: (I) anaesthesia-related adverse events and (II) failed first-pass intubation. Secondary outcomes include patient satisfaction, length of stay in the post anaesthesia care unit and serious adverse events. The trial will randomise 2684 participants to be able to detect a 30% relative risk reduction in failed first pass intubation and anaesthesia-related adverse events, with corresponding power of 80% and 99%, respectively, using a two-sided α of 0.025.PERSPECTIVES: Given the global volume of tracheal intubation, even small differences may have substantial clinical implications. ROCVIDEO will generate high-quality evidence to inform future guidelines aiming to improve global clinical practice.STATUS: As of 15 June 2026, the trial has randomised 707 participants across 15 sites. Recruitment is expected to be completed in the third quarter of 2027.TRIAL REGISTRATION: ClinicalTrials.gov: NCT06564857; EUClinicalTrials.eu: 2025-521405-40-01.

AB - BACKGROUND: Routine use of neuromuscular blocking agents (NMBAs) is widely recommended to facilitate tracheal intubation. However, NMBA use is associated with potential adverse effects, including postoperative respiratory complications, intraoperative awareness and anaphylaxis. Bolus remifentanil is an alternative, but evidence supporting its effectiveness on first-pass success when using video laryngoscopy is sparse. We hypothesise that rocuronium reduces failed first-pass and the risk of induction- or airway-management-related complications compared with bolus remifentanil when using a video laryngoscope.METHODS: ROCVIDEO is a Danish-Swedish, blinded, randomised, controlled trial comparing rocuronium (0.6 mg/kg) with remifentanil (4 μg/kg) at anaesthesia induction for facilitating orotracheal intubation using video laryngoscopy. Eligible adult participants (ASA-class I-III) undergoing general anaesthesia with video laryngoscopy-assisted orotracheal intubation will be randomised to rocuronium or remifentanil in a ratio of 1:1. Anaesthesia will be induced with propofol and optional fentanyl or sufentanil. Intubation will be initiated 120 s after administration of trial medicine. The two co-primary outcomes are: (I) anaesthesia-related adverse events and (II) failed first-pass intubation. Secondary outcomes include patient satisfaction, length of stay in the post anaesthesia care unit and serious adverse events. The trial will randomise 2684 participants to be able to detect a 30% relative risk reduction in failed first pass intubation and anaesthesia-related adverse events, with corresponding power of 80% and 99%, respectively, using a two-sided α of 0.025.PERSPECTIVES: Given the global volume of tracheal intubation, even small differences may have substantial clinical implications. ROCVIDEO will generate high-quality evidence to inform future guidelines aiming to improve global clinical practice.STATUS: As of 15 June 2026, the trial has randomised 707 participants across 15 sites. Recruitment is expected to be completed in the third quarter of 2027.TRIAL REGISTRATION: ClinicalTrials.gov: NCT06564857; EUClinicalTrials.eu: 2025-521405-40-01.

KW - Humans

KW - Remifentanil

KW - Rocuronium

KW - Intubation, Intratracheal/methods

KW - Laryngoscopy/methods

KW - Adult

KW - Randomized Controlled Trials as Topic

KW - Female

KW - Video-Assisted Techniques and Procedures

KW - Anesthesia, General

KW - Neuromuscular Nondepolarizing Agents

KW - Male

UR - https://www.scopus.com/pages/publications/105041955026

U2 - 10.1111/aas.70277

DO - 10.1111/aas.70277

M3 - Journal article

C2 - 42304626

SN - 0001-5172

VL - 70

SP - e70277

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 6

M1 - e70277

ER -

Remifentanil Versus Rocuronium for Optimising Video Laryngoscopy Assisted Tracheal Intubation-The ROCVIDEO Trial Protocol

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Keywords

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