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Background An increasing number of patients older than 80 years are undergoing anesthesia, but little information is available regarding pharmacodynamic effects of myorelaxants in this population. This study aims to compare the time course of rocuronium neuromuscular block in patients ≥ 80 years with those of younger adults. Methods Under total intravenous anesthesia with propofol and sufentanil, time course of a bolus of rocuronium 0.6 mg/kg neuromuscular block was assessed with acceleromyography in patients ≥ 80 and in patients 20–50 years old. Onset time, clinical duration, duration until 90% and 100% recovery of baseline were determined. Results Data from 32 patients were analyzed, 16 were ≥ 80 years and 16 were 20–50 years old. Demographic data are shown in Table 1. In the group ≥ 80, onset time was 190 s ± 46 s compared to 123 s ± 40 s in the group 20–50, P < 0.001 and the clinical duration was 52 [48–69.5] min and 36 [34–41] min, respectively, P < 0.001. Duration to 90% recovery of baseline was 77.5 [71–88.5] min and duration to 100% recovery of baseline was 91.2 [82.2–98] min in patients ≥ 80 years and the corresponding values in the patients 20–50 years old were 53.5 [49–55.5] min and 59.5 [56.5–70.25] min, respectively, P < 0.001. Conclusion Compared to younger adults rocuronium shifted in patients ≥ 80 years from a rapid onset, intermediate acting compound to a slower onset, long-acting compound. Trial registration ClinicalTrials.gov identifier: NCT03551652 (29/05/2018).

Background: Active fluid removal has been suggested to improve prognosis following the resolution of acute circulatory failure. To standardize the deresuscitation strategy, we have implemented a routine care protocol to guide fluid removal during continuous renal replacement therapy (CRRT). We designed a before-after pilot study to evaluate the impact of this deresuscitation strategy on the cumulative fluid balance.Methods: Consecutive ICU patients suffering from fluid overload and undergoing CRRT for acute kidney injury underwent a perfusion-based deresuscitation protocol combining a restrictive intake, continuous net ultrafiltration (UFnet) of 2 mL/kg/h, and both clinical and laboratory monitoring of perfusion (early dry group, N=42) and were compared to an historical group managed according to usual practices (control group, N=45). The primary outcome was the cumulative fluid balance at day 5 or at discharge. Secondary outcomes addressed the protocol safety. Adjustments were done with inverse probability of treatment weighting propensity score analysis.Results: Adjusted cumulative fluid balance was significantly lower in the early dry group (median [IQR]: -7784 [-11833 to -2933] mL) compared to the control group (-3492 [-9935 to -1736] mL, p=0.04). The difference was mainly driven by a greater daily UFnet (31 [22-46] mL/kg/day vs. 24 [15-32] mL/kg/day, p=0.01). There was no significant difference between both groups regarding maximal arterial lactate level and maximal norepinephrine dose requirement. Conclusion: Our perfusion-based deresuscitation protocol achieved a greater negative cumulative fluid balance compared to standard practices and was hemodynamically well tolerated. Those data suggest the feasibility of an interventional randomized clinical trial using a similar protocol.