Neuromuscular block management: evidence-based principles and practice

Rodney, G.; Raju, P.; Brull, S.J.

doi:10.1016/j.bjae.2023.10.005

Cited by 6 publications

(2 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…30 Evidence-based principles for different neuromuscular monitoring techniques in clinical practice have recently been comprehensively summarized in BJA Education . 31 It is advisable for clinicians to familiarize themselves with the specifics of their monitoring technique of choice (and in relation to AMG) for optimal and reliable interpretation of measurements. Ideally in the future, the algorithm will be programmed into a closed-loop system, which was already developed for rocuronium with continuous NMB monitoring.…”

Section: Discussionmentioning

confidence: 99%

A Practical Dosing Algorithm for Deep Neuromuscular Blockade during Total Intravenous Anesthesia: ROCURITHM

Albers-Warlé,

Reijnders-Boerboom,

Bijkerk

et al. 2024

Anesthesiology

View full text Add to dashboard Cite

Background The number of trials investigating the effects of deep neuromuscular blockade (NMB) on surgical conditions and patient outcomes is steadily increasing. Consensus on which surgical procedures benefit from deep NMB (a post tetanic count of 1-2) and how to implement it has not been reached. The ESAIC does not advise routine application but recommends use of deep NMB to improve surgical conditions on indication. This study investigates the optimal dosing strategy to reach and maintain adequate deep NMB during total intravenous anesthesia. Methods Data from three trials investigating deep NMB during laparoscopic surgery with TIVA (n=424) was pooled to analyze the required rocuronium dose, when to start continuous infusion and how to adjust. The resulting algorithm was validated (n=32) and compared to the success rate in ongoing studies where the algorithm was not used (n=180). Results The mean rocuronium dose based on actual bodyweight for PTC 1-2 was 1.0 ± 0.27 mg.kg -1.h -1 in the trials where mean duration of surgery was ±2 hours (116 minutes). An induction dose of 0.6 mg.kg -1 lead to a PTC of 1-5 in a quarter of patients after a mean of 11 minutes. The remaining patients were equally divided over too shallow (additional bolus and direct start of continuous infusion) or too deep; a ±15-minute wait after PTC 0 for return of PTC to ≥1. Using the proposed algorithm, a mean 76% of all 5-minute measurements throughout surgery were on target PTC 1-2 in the validation cohort. The algorithm performed significantly better than anesthesiology residents without the algorithm, even after a learning curve from 0-20 patients (42% on target, P≤.001, Cohen’s d=1.4 [95% CI 0.9, 1.8]) to 81-100 patients (61% on target, P≤.05, Cohen’s d=0.7 [95% CI 0.1, 1.2]). Conclusions We propose a dosing algorithm for deep NMB with rocuronium in patients receiving TIVA.

show abstract

Section: Discussionmentioning

confidence: 99%

A Practical Dosing Algorithm for Deep Neuromuscular Blockade during Total Intravenous Anesthesia: ROCURITHM

Albers-Warlé,

Reijnders-Boerboom,

Bijkerk

et al. 2024

Anesthesiology

View full text Add to dashboard Cite

show abstract

“…Neuromuscular monitoring, which is strongly recommended, would have provided an objective measure of full relaxation. Additionally, the effects of neuromuscular agents vary substantially among patients, so a time-based readiness such as “approximately 3 minutes” for intubation is inaccurate and imperfect . Furthermore, use of succinylcholine as the muscle relaxant to facilitate intubation provides better intubating conditions than rocuronium .…”

mentioning

confidence: 99%