Prevention of laryngospasm with rocuronium in cats: a dose-finding study

Martin‐Flores, Manuel; Sakai, Daniel M.; Portela, Diego A.; Borlle, Lucia; Campoy, Luis; Gleed, Robin D.

doi:10.1111/vaa.12342

Cited by 10 publications

(9 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4 It has been suggested that the laryngeal muscles are more resistant to the effects of rocuronium than fibular or radial nerves, which could explain the apparent similarity in onset time between the reported case and earlier work. 4,6 In contrast, a feline study using subjective evaluation of intubating conditions as an outcome found a slower time to peak effect (60 s) with 0.6 mg/kg rocuronium IV. 3 Furthermore, arytenoid cartilage position was classified as ‘intermediate’ at this dose, 3 with apposition of the vocal folds.…”

Section: Discussionsupporting

confidence: 54%

“…1,5,6 A dose-finding study in cats observed a trend to faster onset of effect and reduced inter-individual variability (improved consistency) with increasing rocuronium doses (0.1–0.6 mg/kg), and visual examination of these data suggests that higher doses may result in a faster onset of effect (Figure 2). 4 The ED 90 of rocuronium in cats has been variably reported as 0.09–0.25 mg/kg. 7,8 High doses of rocuronium have not been clinically evaluated in cats, though an experimental study using an intravenous dose of 1.5 mg/kg reported a duration of action (until recovery of 75% of a twitch response) of approximately 30–40 mins.…”

Section: Discussionmentioning

confidence: 99%

“…6 Extrapolating from available feline data and assuming a similar linear relationship between dose and duration, the mean ± SD clinical duration of 0.6 mg/kg of rocuronium is reported as 18.3 ± 2.4 mins, so the dose used in this case could be expected to last approximately 40 mins. 4,8 The cat was continuously monitored from extubation until the return of sternal recumbency. As a precaution against laryngospasm following extubation, materials necessary to induce anesthesia and perform orotracheal intubation were prepared before removal of the endotracheal tube.…”

Section: Discussionmentioning

confidence: 99%

“…Plot of time to onset of neuromuscular blockade (defined as maximal reduction in first twitch of train-of-four) at four doses of rocuronium (intravenously) in healthy adult cats. From Martin-Flores et al 4 Data are mean ± SD (n = 8)…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Intubation following high-dose rocuronium in a cat with protracted laryngospasm

Doodnaught

Pang

2017

Journal of Feline Medicine and Surgery Open Reports

View full text Add to dashboard Cite

Case summaryAn 11-year-old spayed female domestic shorthair cat with a history of laryngospasm at induction of general anesthesia presented for dental evaluation and treatment. The cat was premedicated with hydromorphone (0.05 mg/kg) and alfaxalone (0.5 mg/kg) intravenously, pre-oxygenated for 5 mins (3 l/min, face mask) and anesthesia was induced with alfaxalone (to effect) intravenously. Lidocaine (0.1 ml, 2%) was applied topically to the arytenoid cartilages following loss of jaw tone. Laryngospasm was not noted during or immediately following lidocaine application. However, after waiting 60 s for the onset of effect of the topical lidocaine, laryngospasm was apparent. Orotracheal intubation by direct visualization was unsuccessful after four attempts by three anesthetists (with increasing levels of experience). At this point, a failed intubation was declared and the non-depolarising neuromuscular blocking agent rocuronium (1 mg/kg IV) given, resulting in arytenoid abduction and appropriate conditions for intubation. Successful intubation occurred 9 mins after induction of anesthesia. Oxygen was continuously supplemented throughout and arterial hemoglobin saturation with oxygen was never <94%.Relevance and novel informationTo the authors’ knowledge, this is the first report of the use of high-dose rocuronium to successfully resolve prolonged laryngospasm at induction of general anesthesia in a cat. Despite laryngospasm and a delay in achieving orotracheal intubation, low values for arterial hemoglobin saturation with oxygen (indicative of hypoxemia) were not observed, highlighting the benefits of pre-oxygenation and apneic oxygenation. The principles of the Difficult Airway Society 2015 guidelines were followed in managing this difficult intubation.

show abstract

Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Intubation following high-dose rocuronium in a cat with protracted laryngospasm

Doodnaught

Pang

2017

Journal of Feline Medicine and Surgery Open Reports

View full text Add to dashboard Cite

show abstract

“…4 A recent dose-finding study in a laboratory setting evaluating the NMBA rocuronium in cats showed that reducing the dose of this agent from 0.6 to 0.3 mg/kg intravenously (IV) can significantly limit the time of apnea while preserving the ability to blunt laryngospasm in response to laryngeal stimulation. 6 However, to our knowledge, whether the technique improves tracheal intubation in a clinical setting has not yet been evaluated.…”

Section: Introductionmentioning

confidence: 99%