Pharmacokinetics and pharmacodynamics of rocuronium in young adult and elderly patients undergoing elective surgery

Varrique, Renan M; Lauretti, Gabriela Rocha; Matsumoto, Julia A; Lanchote, Vera Lúcia; Moraes, Natália Valadares de

doi:10.1111/jphp.12617

Cited by 13 publications

(10 citation statements)

References 32 publications

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“…Rocuronium has an onset time of approximately 135 s, and a clinical duration of action of approximately 81 min in the elderly (>80 years) after administration of 0.6 mg kg 5 . Rocuronium is primarily metabolized in the liver (70% passes unmetabolized via the bile) and excreted via the kidneys 6 . Elderly patients are at higher risk of residual neuromuscular blockade 7,8 which is associated with muscle weakness, double or blurred vision, impaired pulmonary function and a higher risk of postoperative respiratory complications in the post anaesthesia care unit 9,10 …”

Section: Introductionmentioning

confidence: 99%

A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg⁻¹ or remifentanil 2 µg·kg⁻¹ in elderly patients

Madsen

Sørensen

Bjerring

et al. 2021

Acta Anaesthesiol Scand

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Background To facilitate tracheal intubation, either a neuromuscular blocking agent or a bolus dose of remifentanil can be administered. We hypothesized that rocuronium 0.6 mg·kg−1 provided a larger proportion of excellent intubating conditions compared to remifentanil 2 µg·kg−1 in patients above 80 years. Methods A total of 78 patients were randomized to either rocuronium 0.6 mg·kg−1 or remifentanil 2 µg·kg−1. General anaesthesia was initiated with fentanyl and propofol. Two minutes after the administration of either rocuronium or remifentanil, tracheal intubating conditions were evaluated using the Fuchs‐Buder scale by a blinded investigator, and our primary outcome was the proportion of patients presenting intubating conditions deemed as excellent. Further outcomes included the Intubating Difficulty Scale (IDS), hoarseness or sore throat 24 h postoperatively, and intervention against hypotension. Results No difference in the occurrence of excellent intubating conditions was found comparing the rocuronium group with the remifentanil group; 10 (28%) versus 15 (39%) (p = .29), respectively, relative risk = 0.72. Interventions against hypotension were used in 24 (67%) versus 28 (74%) (p = .51), respectively. Hoarseness and sore throat 24 h postoperatively were found in 37% versus 35% p = .86, and 14% versus 5% p = .20, respectively. The IDS score was 2 versus 2 p = .48. Conclusion No difference in intubating conditions was found 2 min after the administration of either rocuronium 0.6 mg·kg−1 or remifentanil 2 µg·kg−1 in patients aged above 80 years. Intubation conditions were less than optimal in a large proportion of this patient population. Clinical trials registration NCT04287426.

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Section: Introductionmentioning

confidence: 99%

A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg⁻¹ or remifentanil 2 µg·kg⁻¹ in elderly patients

Madsen

Sørensen

Bjerring

et al. 2021

Acta Anaesthesiol Scand

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“…Some research indicates that age is a factor that may influence the duration of action of muscle relaxants and that age-related reductions in cardiac output, renal and hepatic function, muscle mass, and the ability to regulate temperature are present in most elderly patients. [3,10]…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that rocuronium leads to significantly longer muscle relaxation in elderly patients than in young adults. [3,10] The incidence of postoperative residual neuromuscular blockade has been reported to be approximately twice as high in elderly patients when compared to younger patients. [3] While repeated administration of cisatracurium during surgery does not lead to prolonged the duration and variability of duration of action.…”

Section: Introductionmentioning

confidence: 99%

Grip strength can be used to evaluate postoperative residual neuromuscular block recovery in patients undergoing general anesthesia

Pei

Zhou

2019

Medicine

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Background:Residual postoperative neuromuscular blockade is an important clinical issue. Neuromuscular monitoring is usually used to evaluate neuromuscular recovery in patients undergoing general anesthesia. However, this procedure is inconvenient and not widely adopted. We aimed to examine the correlation between grip strength and train-of-four ratio (TOFr) to examine whether assessing grip strength can be used clinically to monitor residual neuromuscular blockade.Methods:One hundred twenty patients with ASA I or II scheduled for laparoscopic cholecystectomy under general anesthesia were enrolled in this study. All patients were randomly selected to receive standard anesthesia induction with either 0.6 mg·kg−1 rocuronium or 0.2 mg·kg−1 cisatracurium. Grip strength was tested in all patients using an electronic device before anesthesia and when TOFr values of 0.7, 0.8, and 0.9, and an hour later of TOFr value of 0.25. The time required for a change in TOFr values from 0.25 to 0.75 and 0.9 was evaluated. Spearman rank correlation analysis was performed to determine correlations between grip strength and TOFr.Results:Spearman rank correlation analysis indicated that there was a significant correlation between grip strength and TOFr during patient recovery from general anesthesia (correlation coefficient for grip strength recovery [rs] = 0.886). Subgroup analysis revealed that there were no differences in mean maximum grip value recovery between patients treated with rocuronium and those treated with cisatracurium when TOFr was 0.7, 0.8, and 0.9 or when the TOFr was 0.25 after 60 minutes (all P >.05). Recovery of TOFr from 0.25 to 0.75 and from 0.25 to 0.9 was longer in patients treated with rocuronium than in those treated with cisatracurium (both P <.001).Conclusion:There was a strong correlation between grip strength and TOFr during recovery from general anesthesia. Evaluation of grip strength can be used as an additional strategy to evaluate postoperative residual neuromuscular blockade.

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“…From the pharmacokinetics standpoint, it is expected that recurarization occurs when low dose of sugammadex is administered to patients with deep muscle paralysis as demonstrated in previous studies. [20][21][22][23][24][25] Other studies demonstrated that the elderly patients respond differently to rocuronium 26,27 and sugammadex 28,29 in comparison with nonelderly patients, suggesting age-related differences in the pharmacodynamics and pharmacokinetics of rocuronium and sugammadex. We considered that potential pharmacodynamics/pharmacokinetics differences may be assessible by the change of the train-of-four ratio (primary outcome variable) between age groups.…”

Section: Editor's Perspective What We Already Know About This Topicmentioning

confidence: 99%

Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients

et al. 2018

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Complete recovery from rocuronium-induced muscle paralysis with sugammadex is reported to be delayed in elderly patients. The authors tested a hypothesis that recovery from deep neuromuscular block with low-dose sugammadex is slower (primary hypothesis) and incidence of recurarization is higher (secondary hypothesis) in elderly patients than in nonelderly patients. Methods In anesthetized elderly (n = 20; 76.9 ± 5.0 yr of age) and nonelderly patients (n = 20; 53.7 ± 12.8 yr of age) under deep paralysis with rocuronium, change of train-of-four ratio per minute (primary outcome variable) was measured with an acceleromyograph neuromuscular monitor during spontaneous recovery from rocuronium-induced muscle paralysis (0.6 mg/kg) and after infusion of low-dose sugammadex (50 µg · kg-1 · min-1). Recurarization was defined as the negative change of train-of-four ratio. Results Spontaneous train-of-four ratio recovery rate was significantly slower in the elderly group (median [25th percentile, 75th percentile]: 1.89 [1.22, 2.90] %/min) than in the nonelderly group (3.45 [1.96, 4.25] %/min, P = 0.024). Train-of-four ratio change rate in response to low-dose sugammadex was significantly slower in elderly (0.55 [–0.29, 1.54] %/min) than in the nonelderly group (1.68 [0.73, 3.13] %/min, P = 0.024). Incidence of recurarization was significantly higher in the elderly group than in the nonelderly group (35% vs. 5%, P = 0.044). Multiple linear regression analyses indicate that slower spontaneous train-of-four ratio recovery rate and impaired renal function are two major contributing factors that decrease train-of-four ratio change rate in response to low-dose sugammadex. Conclusions Elderly patients are at greater risk for recurarization and residual muscle paralysis when low-dose sugammadex is administered.

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Pharmacokinetics and pharmacodynamics of rocuronium in young adult and elderly patients undergoing elective surgery

Cited by 13 publications

References 32 publications

A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg⁻¹ or remifentanil 2 µg·kg⁻¹ in elderly patients

A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg⁻¹ or remifentanil 2 µg·kg⁻¹ in elderly patients

Grip strength can be used to evaluate postoperative residual neuromuscular block recovery in patients undergoing general anesthesia

Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients

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Pharmacokinetics and pharmacodynamics of rocuronium in young adult and elderly patients undergoing elective surgery

Cited by 13 publications

References 32 publications

A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg−1 or remifentanil 2 µg·kg−1 in elderly patients

A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg−1 or remifentanil 2 µg·kg−1 in elderly patients

Grip strength can be used to evaluate postoperative residual neuromuscular block recovery in patients undergoing general anesthesia

Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients

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Product

Resources

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A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg⁻¹ or remifentanil 2 µg·kg⁻¹ in elderly patients

A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg⁻¹ or remifentanil 2 µg·kg⁻¹ in elderly patients