Neuromuscular effect of dexmedetomidine on sevoflurane: an open-label, dose-escalation clinical trial

Hh, Ke; Wu, H-H; Zhu, Quing; Zhang, Y; Xiao, Mei; Su, Xin-zhuan; Wj, Zheng; Yp, Cai; Xz, Wu; Yt, Wang; Chen, GZ

doi:10.23736/s0375-9393.16.11580-9

Cited by 2 publications

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“…2,20 Second, the potentiation of NMB and the central neuromuscular effects of volatile anaesthetics may also be an important reason for this result. 14,[21][22][23] Our results also showed that shallow and moderate NMB significantly reduced adverse events during induction and maintenance of anaesthesia compared with no NMB. In particular, NMB significantly reduced the occurrence of clinically unacceptable intubation conditions, and this may reduce the risk of peri-operative respiratory complications in neonates and small infants.…”

Section: Discussionsupporting

confidence: 68%

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Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants

Wu,

Wei,

Xiang

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Neuromuscular block (NMB) is routinely used in paediatric and adult anaesthesia to facilitate endotracheal intubation and optimise surgical conditions. However, there are limited data regarding NMB and optimising the conditions for laparoscopic surgery in neonates and small infants. OBJECTIVE The goal of this study was to determine the effect of NMB on the conditions for laparoscopic surgery in neonates and small infants. DESIGN A randomised controlled trial. SETTING Single-centre Children's Hospital, conducted from November 2021 to December 2022. PATIENTS One hundred and two ASA I–II neonates and small infants aged up to 60 weeks postmenstrual age who were scheduled to undergo an elective laparoscopic Ladd's procedure were included in the study. INTERVENTIONS Patients were randomised into three groups: no NMB group, shallow NMB group and moderate NMB group. Each group was given different doses of rocuronium to achieve the target depth of NMB. MAIN OUTCOME MEASURES The primary outcome was the quality of the surgical conditions evaluated with the Leiden-Surgical Rating Scale (L-SRS) by a blinded surgeon. Secondary outcomes included tracheal intubating conditions and adverse events. RESULTS The percentage of L-SRS scores of 4 or 5 was similar among the three groups at all the assessment times (P > 0.05 for each time interval). The distribution of L-SRS scores was also similar among the three groups. There were no significant differences in operating condition scores between the groups at any time interval (P > 0.05 for each time interval). The incidence of adverse events during anaesthesia induction was significantly higher in the no NMB group (51.4%) than in the other two groups (13.6% and 14.7%) (adjusted P = 0.012 and adjusted P = 0.003). In particular, clinically unacceptable intubation conditions occurred in 12 patients (34.3%) in the no NMB group, significantly more than in the shallow NMB group (6.1%, adjusted P = 0.012) and moderate NMB group (2.9%, adjusted P = 0.003). There was no statistically significant difference in the incidence of adverse events in the PACU among the three groups (P = 0.103). CONCLUSIONS The depth of NMB was not associated with superior surgical conditions during laparoscopic surgery, but it was associated with a reduction in adverse events during induction and maintenance of anaesthesia in neonates and small infants. TRIAL REGISTRATION Registered at www.chictr.org.cn (ChiCTR2100052296).

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Section: Discussionsupporting

confidence: 68%

“…The main reason for this result may be immature abdominal wall muscles and weak muscle tension in neonates and small infants 2,20 . Second, the potentiation of NMB and the central neuromuscular effects of volatile anaesthetics may also be an important reason for this result 14,21–23 …”

Section: Discussionmentioning

confidence: 99%

Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants

Wu,

Wei,

Xiang

et al. 2023

European Journal of Anaesthesiology

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Resveratrol alleviates diabetic mechanical allodynia in rats by downregulating P2X3R

Cui

Ning

et al. 2020

Mol Med Rep

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Mechanical allodynia, which develops in patients of diabetes mellitus as a neuropathic manifestation, remains without an effective treatment. The aim of the present study was to investigate the effects and potential mechanisms underlying resveratrol (reS) in a rat model of streptozocin (STZ)-induced diabetic mechanical allodynia (dMa). The rat model of dMa was established by the administration of an intraperitoneal injection of STZ. From day 8 post-STZ injection, rats were administered with an intragastric injection of various doses of RES for 14 consecutive days. The von Frey filaments were applied to detect the paw withdrawal threshold and evaluate the analgesic effects of reS. Based on the dose-effect curve, the ed 50 of RES was calculated. Immunofluorescence staining and western blotting were performed to detect the expression of purinergic receptor P2X3 (P2X3r) in the dorsal root ganglion (drG) and spinal dorsal horn (SdH) following reS ed50 treatment. The results indicated that reS significantly alleviated mechanical allodynia in dMa model rats in a dose-dependent manner. compared with the control group, the expression of P2X3r in drG neurons and SdH terminals was markedly decreased following the administration of reS ed50 (P<0.05). collectively, the results indicated that reS displayed a dose-dependent analgesic effect on dMa model rats. Furthermore, P2X3r expression downregulation in the drG and SdH may be a mechanism underlying the analgesic effects of reS on dMa-related behaviors.

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Neuromuscular effect of dexmedetomidine on sevoflurane: an open-label, dose-escalation clinical trial

Cited by 2 publications

References 0 publications

Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants

Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants

Resveratrol alleviates diabetic mechanical allodynia in rats by downregulating P2X3R

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