Neuromuscular Effects of Rocuronium Bromide in Patients in Statin Therapy for at least Three Months

Abstract

Statins cause skeletal muscle myopathy. However, the neuromuscular effects of non-depolarizing neuromuscular-blocking agent in patients in long-term statin therapy remain unclear. Hence, we investigated the neuromuscular effects of rocuronium and muscle injury in patients in long-term statin therapy. Eighteen statin users using statins for at least 3 months were included in the statin group and 18 non-statin users were included in the non-statin group. General anaesthesia was induced with intravenous midazolam, etomidate, sufentanil and rocuronium 0.9 mg/kg (3ED ) for intubation. Anaesthesia was maintained with 1% propofol and remifentanil. The onset time and duration 10% T and 25% T of rocuronium were recorded. Blood samples were obtained before induction and 5 min., 1 hr, 2 hr, 4 hr, 12 hr and 24 hr after rocuronium administration to measure creatine kinase (CK), myoglobin and potassium. Myalgia was determined at 2 and 24 hr after surgery. There were no significant differences in the basic clinical characteristics between the two groups. The onset time of the statin group was significantly shorter than that of the non-statin group (p = 0.02), while the duration 10% T and duration 25% T of the statin group were significantly longer than those of the non-statin group (p = 0.006; p = 0.045). The myoglobin and CK concentrations increased after rocuronium administration as compared to baseline in both groups. CK concentration in the statin group was significantly higher than in the non-statin group just at 24 hr (p = 0.000003). However, myoglobin showed no significant difference between the two groups. The onset time of rocuronium decreases and its duration time increases in patients in long-term statin therapy.

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

“…However, statins increase muscle creatine kinase (CK) with muscle toxicity. With long-term administration, the onset time of NMBDs is delayed and the duration of action is reduced [ 78 79 ].…”

A Validated Ultra-High-Pressure Liquid Chromatography Method for Separation of Sugammadex Related Substances and its Degradants in Drug Product

“…Vecuronium bromide and rocuronium bromide are neuromuscular blocking medications that cause temporary paralysis and are especially useful for ventilation, general anesthesia, or tracheal intubation that patients may require for surgery [13]. Some clinical studies of neuromuscular blocking drugs; documented that incomplete recovery is associated with various side effects such as muscle weakness, airway obstruction, and respiratory complications [14,15]. Sugammadex provides a new treatment option to reverse the effects of those medications and possibly help patients quicker recovery and minimal side effects sooner post-surgery [8][9][10][11][12][13][14][15][16].…”

“…Some clinical studies of neuromuscular blocking drugs; documented that incomplete recovery is associated with various side effects such as muscle weakness, airway obstruction, and respiratory complications [14,15]. Sugammadex provides a new treatment option to reverse the effects of those medications and possibly help patients quicker recovery and minimal side effects sooner post-surgery [8][9][10][11][12][13][14][15][16].…”