Effect of Smoking on Reversing Neuromuscular Block

Abstract

Objective: Rocuronium is a non-depolarising, intermediate-acting, monoquaternary amino steroid and was brought into clinical use as a potentially ideal muscle relaxant. Post-operative residual curarisation (PORC) results from the prolonged effects of non-depolarising neuromuscular blocking agents. This is a common problem and seriously affects patient safety. No recent study has investigated the effects of sugammadex on smokers, which is often used to restore neuromuscular block and avoid PORC. This study compares the severity of the effects of sugammadex used for antagonising rocuronium bromide and antagonism durations in smokers and non-smokers.Methods: This randomised, prospective study included 40 patients scheduled for elective surgery and belonging to classes I and II based the American Society of Anesthesiologists classification, who were either smokers for at least 10 years or non-smokers. Patients underwent routine and neuromuscular monitoring. At induction, 2 mg kg −1 propofol and 1 mcg kg −1 intravenous fentanyl were applied. After the loss of eyelash reflex, 0.6 mg kg −1 intravenous rocuronium was administered. Patients were intubated at train of four (TOF) 2. Anaesthesia was continued with 50% O 2 +50% air and 2% sevoflurane. Rocuronium, 0.15 mg kg −1 , was administered at TOF 2 during the operation. At the end of the operation, 2 mg kg −1 sugammadex was administered. The times until TOF 0.7, 0.8 and 0.9 were recorded.Results: Intubation time was 132.8±46.4 s for smokers and 127.6±32.7 s for non-smokers. After sugammadex administration, the time to TOF 0.7 was 153.3±54.7 s in smokers and 125±67.2 s in non-smokers. The times were 178.4±58.8 and 146.6±72.6 s for TOF 0.8 and 200.8±55.8 s and 170.4±77.8 s for TOF 0.9 in smokers and non-smokers, respectively. Conclusion:Although not statistically significant, the time to reach each TOF was longer for smokers. Larger populations and different perspectives are needed to find if sugammadex use is affected by smoking, which has negative effects on the body. Keywords: General anaesthesia, sugammadex, smokingAmaç: Rokuronyum orta etki başlama süresine sahip, aminosteroid yapıda non depolarizan steroid kas gevşeticidir ve ideal kas gevşetici bulma çabaları sonucunda klinik amaçlı kullanılmaya başlanmıştır. Postoperatif kürarizasyon (PORC) non-depolarizan kas gevşeticilerin etkisinin uzaması sonucu ortaya çıkar. Bu önemli sorun günümüzde hala yaygındır ve hasta güvenliğini ciddi bir şekilde etkilemektedir. Literatür taramamızda sigara içiminin nöromuskuler bloğun etkisini ortadan kaldırmak ve PORC'dan kaçınmak için daha sık kıllanılan sugammadex üzerine etkisini araştıran bir çalışma bulunmamıştır. Bu çalışmanın amacı sigara kullanımının rokuronyum bromürü antagonize etmek için kullanılan sugammadexin etkinliği üzerine etkisini araştırmaktır.Yöntemler: Prospektif randomize çalışmaya ASA 1-2; son 10 yıl-dır sigara içen veya hiç içmeyen elektif cerrahi hazırlığı yapılan hastalar dahil edildi. Hastalara rutin vital bulgu monitorizasyonu ve nöromuskuler monitörizasy...