Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin

Hasfurther, Daniel L.; Bailey, Peter L.

doi:10.1007/bf03011775

Cited by 16 publications

(12 citation statements)

References 10 publications

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“…Certain classes of drugs are known to potentiate the activity of the neuromuscular blocking agents (NMBAs) if used in the perioperative setting [6-11], including several antibiotics [6,9-11]. Furthermore, the presence of certain antibiotics may limit the ability of traditional reversal agents such as neostigmine to reverse NMB [6,12]. In cases where neostigmine is found to be ineffective, this may be a consequence of the antibiotic potentiating NMB through inhibition of acetylcholine release from the nerve terminal.…”

Section: Introductionmentioning

confidence: 99%

Sugammadex is effective in reversing rocuronium in the presence of antibiotics

2014

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BackgroundThe effectiveness of sugammadex in reversing rocuronium-induced neuromuscular blockade (NMB) in the presence of drugs that may potentiate NMB remains to be fully established. The aim of this post-hoc analysis of data from a Phase III clinical trial (VISTA; NCT00298831) was to investigate the impact of antibiotics on recovery from rocuronium-induced NMB after administration of sugammadex for reversal, and compared the neuromuscular recovery in patients who received antibiotics preoperatively with those who did not.MethodsA Phase III, multicenter, open-label study designed to reflect potential use of sugammadex in clinical practice was conducted at 19 sites. Data obtained from patients who received antibiotics were compared with the cohort of patients who underwent the same protocol without antibiotics. Each subject received rocuronium 0.6 mg/kg for muscle relaxation, after which tracheal intubation was performed; patients were also permitted to receive maintenance doses of rocuronium 0.15 mg/kg to maintain the desired level of NMB throughout the operation, as required.. At least 15 min after the last rocuronium dose, patients received sugammadex 4.0 mg/kg for reversal. Neuromuscular monitoring was continued until a train-of-four (TOF) ratio of ≥0.9 was achieved or the anesthetic was discontinued.ResultsThe presence of antibiotics prior to the administration of sugammadex did not affect the recovery time from rocuronium-induced NMB when sugammadex 4.0 mg/kg was administered at least 15 min after the last dose of rocuronium. In the presence of antibiotics, the geometric mean (95% CI) time from administration of sugammadex 4.0 mg/kg to recovery of the TOF ratio to ≥0.9 was 1.6 (1.4–1.9) min (range: 0.7–10.5 min), compared with 2.0 (1.8–2.3) min (range: 0.7–22.3 min) for patients who did not receive antibiotics.ConclusionsThese findings suggest that prophylactic antibiotic use is unlikely to have a major impact on the recovery time from rocuronium-induced NMB with sugammadex reversal.Trial registrationClinicalTrials.gov Identifier: NCT00298831.

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Section: Introductionmentioning

confidence: 99%

Sugammadex is effective in reversing rocuronium in the presence of antibiotics

2014

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“…Neomycin also alters the calcium influx into the presynaptic nerve terminal, thereby reducing the amount of acetylcholine release [9,10]. The potentiation of neuromuscular block produced by an aminoglycoside antibiotic is known to be resistant to the effects of neostigmine [10]. Calcium is more reliable and predictable than neostigmine for the reversal of neuromuscular block produced by neomycin [10,11].…”

Section: Discussionmentioning

confidence: 97%

“…The potentiation of neuromuscular block produced by an aminoglycoside antibiotic is known to be resistant to the effects of neostigmine [10]. Calcium is more reliable and predictable than neostigmine for the reversal of neuromuscular block produced by neomycin [10,11]. Calcium interacts with, or competes with, neomycin during some part of the prejunctional process before the release of acetylcholine.…”

Section: Discussionmentioning

confidence: 98%

“…Neomycin, another aminoglycoside antibiotic, reduces the amount of transmitter released from the presynaptic membrane in response to an action potential. Neomycin also alters the calcium influx into the presynaptic nerve terminal, thereby reducing the amount of acetylcholine release [9,10]. The potentiation of neuromuscular block produced by an aminoglycoside antibiotic is known to be resistant to the effects of neostigmine [10].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anesthesia for craniotomy in a patient with previous paralytic polio

Suneel

Sinha

Unnikrishnan

et al. 2008

Journal of Clinical Anesthesia

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“…A neuromuscular blockage can be increased by all aminoglycoside antibiotics. It was previously reports that there is a real difficulty to antagonize the action of rocuronium after using oral neomycin [8]. There is an animal study [9] showed that gentamicin has prolonged the neuromuscular blocking action of atracurium.…”

Section: Introductionmentioning

confidence: 99%