Postoperative muscle paralysis after rocuronium: less residual block when acceleromyography is used

Gätke, Mona Ring; Viby‐Mogensen, J.; Rosenstock, C.; Jensen, Flemming; Skovgaard, L. T.

doi:10.1034/j.1399-6576.2002.460216.x

Cited by 94 publications

(64 citation statements)

References 26 publications

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“…Many studies have observed that monitorization of neuromuscular transmission decreases the frequency of PORC (16,17). It is recommended that monitorization of neuromuscular transmission be performed primarily in elderly patients, in dysfunction of the kidney and liver, in patients with cardiovascular disease and asthma, in diseases involving neuromusculoskeletal system, in those who are morbidly obese, and in long lasting surgical interventions.…”

Section: Resultsmentioning

confidence: 99%

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

Yazar¹,

Yılmaz²,

Bilgin³

et al. 2016

Balkan Med J

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Background:The importance of the characteristics of anesthesia and postoperative residual curarization (PORC) in the elderly population should be a growing concern in this century. Aims: To investigate the effect of sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization in the young elderly and middle-aged elderly patients who underwent elective laparoscopic cholecystectomy, followed by a train of four (TOF) watch monitorization. Study Design: Prospective clinical trial study. Methods: Sixty patients over the age of 65 with American Society of Anesthesiologists I-III were divided into two groups according to their age (65-74 years old and ≥75 years old). Patients received sugammadex (2.0 mg/ kg iv) at the reappearance of the second twitch of the TOF as an agent for reversal of neuromuscular blockage at the end of surgery. Patients were extubated at the time of TOF ≥0.9. The patients' TOF responses were evaluated with regards to PORC in at the 5th minute and were followed up for one hour in the recovery room. Reintubation was applied for those patients who developed PORC and had peripheric oxygen saturation <90% despite being given 6 L oxygen per min with a face mask. Results: The onset time of neuromuscular blocking agent and time from T 2 to achieve TOF ratio 90% (the duration of sugammadex effect) or over were found to be longer in the middle-aged elderly group than in the young elderly group. A statistically significant relationship was found between age and the duration of TOF ratio to reach 0.9 in the same direction. The PORC incidence and rate of reintubation were found to be 1.7% in all patients. Conclusion: In our opinion, it is necessary to remember that the duration of sugammadex effect on the recovery period is prolonged for patients who are aged ≥75 years compared to patients aged between 65-74 years. (ClinicalTrials.gov Identifier: ACTRN12615000758505) Keywords: Elderly, postoperative residual curarization, reintubation, sugammadex Young elderly people, middle-aged elderly people, and old elderly people have been classified, respectively, between 65-74 years of age, between 75-84 years of age, and over age 84 by gerontologists (1). A number of studies have indicated that the prevalance of postoperative residual curarization (PORC) increases with age (2,3).The principle of train of four (TOF) Watch was to indicate a pattern of stimulation that did not require the comparison of evoked responses to a control response obtained before administration of a neuromuscular blocking agent (NMBA). As well as enabling the observer to compare T 1 (first twitch of the TOF) to T 0 (control), it also enables comparison of T 4 (fourth

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Section: Resultsmentioning

confidence: 99%

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

Yazar¹,

Yılmaz²,

Bilgin³

et al. 2016

Balkan Med J

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“…Bununla birlikte Gatke ve ark. [15] orta etkili bir kas gevşetici ajan olan roküronyuma bağlı rezidüel bloğun nöromusküler monitörizasyonla minimalize edilebileceğini bildirmişlerdir. Bizim olgumuzda hem intraoperatif nöromusküler monitörizasyon uygulanmamasının hem de orta etkili bir kas gevşetici olmasına rağmen roküronyumun infüzyon şeklinde kullanılmasının postoperatif rezidüel bloğa neden olabileceğini düşünüyoruz.…”

Section: Discussionunclassified

Neostigminin başarısız olduğu roküronyuma bağlı rezidüel kürarizasyonda sugammadeks kullanımı

Tuzcu¹,

Davarcı²,

Karcioglu³

et al. 2012

CMJ

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ÖzetNondepolarizan kas gevşetici ajanların etkilerinin uzamasına bağlı olarak gelişen postoperatif rezidüel kürarizasyon modern anestezide hala yaygın görülen ve hasta güvenliğine ciddi tehdit oluşturan önemli bir problemdir. Anestezi sonrasında rezidüel nöromusküler blok, uygun şekilde döndürülmezse postoperatif pulmoner komplikasyonların gelişimini ve postoperatif mortaliteyi arttırır. Spinal kitle nedeniyle opere edilen Amerikan Anestezistler Derneği II risk grubu olgumuzda nöromusküler bloker olarak roküronyum kullanıldı. Operasyonun sonunda roküronyuma bağlı rezidüel nöromusküler bloğu döndürmek için neostigmin kullanılmasına rağmen hastada solunum yetmezliği gelişti. Kas gücü yetersiz olan hasta ajite, taşikardik, takipneik ve tidal volümü düşüktü. Postoperatif rezidüel kürarizasyonu döndürmede neostigminin başarısız olması üzerine, hastaya modifiye γ-siklodekstrin yapısındaki 200 mg sugammadeks uygulandı. Nöromusküler bloğun hızlı ve etkili bir şekilde döndüğü tespit edildi. Sonuç olarak geleneksel antikolinerjik ajanların başarısız olduğu roküronyuma bağlı rezidüel kürarizasyonda sugammadeks kullanımının güvenilir ve etkin olduğunu düşünüyoruz. Anahtar sözcükler: Sugammadeks, Neostigmin, Rezidüel kürarizasyon AbstractPostoperative residual curarization caused by prolonged effect of non-depolarizing neuromuscular blocking agents is still a serious, frequent and life threatening problem in modern anesthesia. If postoperative residual neuromuscular block cannot be recovered properly, postoperative pulmonary complications and mortality may increase. We used rocuronium as a neuromuscular blocker in our American Society of Anesthesiologists II risked patient which was operated for a spinal mass. Respiratory failure was occurred in our patient despite the usage of neostigmine for recovering neuromuscular block caused by rocuronium. The patient was tachycardic, tachypneic, the tidal volume was decreased and the muscle strength was weak. After the ineffectiveness of neostigmine in recovering neuromuscular blockage, 200mg sugammadex which is a modified γ-cyclodextrin was given to the patient. We observed that neuromuscular blockage was recovered rapidly and effectively. In conclusion, we think that using sugammedex is effective and safe in residual curarization caused by rocuronium in which traditional anticholinergic agents are not successful.

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“…La incidencia de BNMR presenta una gran variabilidad con porcentajes que oscilan entre el 2% y el 64% 87,93,94,95,96,97,98,99,100,101,102,103,104,105 .…”

Section: Incidencia De Bnmrunclassified

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

Ruiz

Cayuela

Montes

et al. 2017

Revista Española de Anestesiología y Reanimación

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Postoperative muscle paralysis after rocuronium: less residual block when acceleromyography is used

Abstract: Clinical evaluation of recovery of neuromuscular function does not exclude significant residual paralysis following the intermediate-acting muscle relaxant rocuronium, but the problem of residual block can be minimized by use of AMG.

Cited by 94 publications

References 26 publications

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

Neostigminin başarısız olduğu roküronyuma bağlı rezidüel kürarizasyonda sugammadeks kullanımı

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

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