Onset and Duration of Rocuronium and Succinylcholine at the Adductor Pollicis and Laryngeal Adductor Muscles in Anesthetized Humans

Wright, Peter M.; Caldwell, James E.; Miller, Ronald D.

doi:10.1097/00000542-199411000-00004

Cited by 162 publications

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“…Meistelman et al 14 observed a significantly shorter onset time at the larynx (1.4 ± 0.1 min) than at the AP (2.4 ± 0.2 min) after administration of rocuronium 0.5 mg·kg -1 . Wright et al 15 found a shorter onset time at the larynx (92 ± 29 sec) vs the AP (155 ± 40 sec) after application of rocuronium 0.4 mg·kg -1 but similar onset times after rocuronium 0.8 and 1.2 mg·kg -1 . In both studies neuromuscular transmission was monitored by the cuff pressure method at the larynx and mechanomyography at the AP.…”

Section: Objectifmentioning

confidence: 95%

A priming technique accelerates onset of neuromuscular blockade at the laryngeal adductor muscles

Schmidt

Irouschek

Muenster

et al. 2005

Can J Anesth/J Can Anesth

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Section: Objectifmentioning

confidence: 95%

A priming technique accelerates onset of neuromuscular blockade at the laryngeal adductor muscles

Schmidt

Irouschek

Muenster

et al. 2005

Can J Anesth/J Can Anesth

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“…The mean onset time of succinylcholine 1 mg/ kg is reported to be 56 s [3]. We successfully re-established neuromuscular block with a similar onset time, even after the initial use of rocuronium and sugammadex.…”

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confidence: 65%

The use of succinylcholine after sugammadex reversal

Asakura

Iwasaki

2016

J Anesth

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relaxants may cause resistance to the effects of succinylcholine [2]. The mean onset time of succinylcholine 1 mg/ kg is reported to be 56 s [3]. We successfully re-established neuromuscular block with a similar onset time, even after the initial use of rocuronium and sugammadex. Since little is known about the effects of residual nondepolarizing muscle relaxants on succinylcholine, it is important to administer an adequate dose of sugammadex according to objective neuromuscular monitoring to prevent residual neuromuscular block. Keywords Succinylcholine · SugammadexTo the Editor:We recently reported a case series on re-establishment of neuromuscular block with rocuronium after sugammadex reversal [1]. We found no reports on the usage of succinylcholine to re-establish neuromuscular block, therefore we present our case. A 69-year-old female (weight 57.5 kg) was scheduled for right breast total resection. Anesthesia was induced and maintained with propofol, remifentanil, and fentanyl. A total of 50 mg rocuronium was given during the surgery. Sugammadex 120 mg (2 mg/kg) was administered before extubation when spontaneous breathing was observed. After the initial surgery, the patient underwent hemostatic surgery for continuous postoperative bleeding. Anesthesia was induced with propofol and remifentanil, and ulnar nerve stimulation was performed using TOF Watch ® (Organon, Dublin, Ireland). A 50-mA train-of-four (TOF) stimulation was delivered every 15 s. Succinylcholine 60 mg (1 mg/kg) was administered 3 h after sugammadex administration. TOF responses disappeared at 85 s and tracheal intubation was successfully performed. It is known that sugammadex does not affect the onset of succinylcholine. However, residual nondepolarizing muscle This comment refers to the article available at

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“…9 When large doses of relaxants are given (_> 3 x ED9s), as in the present study, it is anticipated that optimal intubating conditions develop before loss of TOF response at the hand because neuromuscular blockade in the central airway musculature shows more rapid kinetics and dynamics than in the hand. [10][11][12] With divided dose mivacurium, T~ at intubation was about 50% of control, compared with 8% of control after an eqnipotent dose of rocuronium. It is possible that the waiting period of 90 sec after the initial dose of mivacurium, or 60 sec after the second dose of mivacurium, was insufficient to allow development of full neuromuscular blockade at the resistant muscles.…”

Section: Discussionmentioning

confidence: 97%

Intubating conditions and neuromuscular block after divided dose mivacurium or single dose rocuronium

et al. 1997

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Purpose: To evaluate the tracheal intubating conditions and neuromuscular blocking charactenstics of divided dose mivacurium or single dose rocuronium. Methods: Thirty-two patients undergoing elective surgery were studied. Anaesthesia was with propofol 2 mg.kg -~ , followed by an infusion of 150/t/g.kg-l-min -I. Patients were randomized to receive either mivacurium-0.15 mg'kg -~ followed 30 sec later by 0. I mg-kg -I, or rocuronium-0.9 mg'kg -I, followed 30 sec later by placebo. Tracheal intubating conditions were assessed 90 sec after the initial dose of relaxant by an anaesthetist who was unaware of patient group. The electromyographic (EMG) response of the first dorsal interosseus muscle to ulnar nerve train-of-four was measured. Results: Successful tracheal intubation was performed in all patients after both mivacurium and rocuron~um. Intubating conditions (jaw relaxation, open visible vocal cords) were judged to be good-excellent in all but one patient before insertion of the tracheal tube. However, patients receiving mivacurium were more likely to experience coughing and bucking after tracheal tube insertion (10/I 6 patients) than those receiving rocuronium (3/I 6 patients, P < 0.05). No patient in the rocuronium group experienced moderately vigorous coughing and bucking after insertion of the tracheal tube vs six patients in the mivacurium group (P < 0.05). Time to I 0 and 25% recovery of neuromuscular function was faster (P < 0.05) after divided dose mivacunum (20 + I and 23 -+-I min, respecttvely) than after rocuronium (45 +--5 and 57 4-8 min, respectively). Conclusion: The results suggest that, during conditions of the study, dMded dose mivacurium is not recommended for a 90-sec tracheal intubation in patients where moderate coughing and bucking is deemed unacceptable. Obj 9: I~valuer les conditions de I'intubation de la tract'~e et les caract&istiques du bloc neuromusculaire au mivacurium ,5 dose fractionn~e et au nocuronium i~ dose unique. M~thodes : Cette ~tude r~unissait 22 patients programrr~s pour une chirurgie non urgente. I'anestl%sie ~tait r~alis~e avec du propofol 2 mg'kg -I, sum d'une perfusion de 150/Jg.kg -P.min -~. Les patients recevaient al~atoire-ment soit du mivacurium 0,15 mg'kg -~ sum 30 sec plus tard par 0, I mg.kg -I, soit du rocuronium 0,9 mg.kg -~, suivi 30 sec plus tard d'un placebo. Les conditions d'intubation de la trachf_~e ~taient ~valu~_~es 90 sec aprcSs la dose initiale de myorelaxant par un anesth~siste ignorant le groupe auquel le patient appartenait. La r~ponse ~lectromyo-graphique (EMG) ,~ la stimulation au train-de-quatre (TOF) du premier muscle interosseux dorsal ~tait mesur~ae. l~.sultats : I'intubation de la trach~e a ~t~ r~Jssie chez tous les patients des deux groupes. Les conditions d'intubation (relaxation de la m~choire, visualisation de cordes vocales b~antes) avant I'insertion de la canule trach6ale ~taient jug~es de bonnes ,~ excellentes chez tousles patients ~ rexception d'un seul. Cependant, les patients sous mivacurium ~ataient plus sujets i~ la toux et a...

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Onset and Duration of Rocuronium and Succinylcholine at the Adductor Pollicis and Laryngeal Adductor Muscles in Anesthetized Humans

Cited by 162 publications

References 0 publications

A priming technique accelerates onset of neuromuscular blockade at the laryngeal adductor muscles

A priming technique accelerates onset of neuromuscular blockade at the laryngeal adductor muscles

The use of succinylcholine after sugammadex reversal

Intubating conditions and neuromuscular block after divided dose mivacurium or single dose rocuronium

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