Priming technique can alleviate the withdrawal responses associated with intravenous administration of rocuronium

Lee, Jae-In; Lim, Se Hun; Lee, Sang Eun; Kim, Young Hwan; Lee, Jeong Han; Lee, Kun Moo; Cheong, Soon Ho; Choe, Young Kyun; Kim, Young Jae; Shin, Chee Mahn

doi:10.4097/kjae.2009.56.6.628

Cited by 6 publications

(8 citation statements)

References 25 publications

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“…This may be because Korean medical staff have a greater ability to detect RIWM, or have a medical mission that aims to reduce RIWM, as Koreans may be particularly sensitive to rocuronium-injection-induced pain. The overall incidence of RIWM in this study was 80% (range, 56-100%) [ 27 , 39 , 42 , 46 , 49 ], which is higher than those of a previous meta-analysis [ 7 ] and reports [ 2 , 53 , 54 , 55 ]. This might be why RIWM study protocols are relatively simple compared with those used in other studies.…”

Section: Discussioncontrasting

confidence: 64%

“…Thirteen studies mentioned the method of random sequence generation [11,12,13,14,15,16,17,18,19,20,21,22,23], and 10 studies used allocation concealment [11,14,23,24,25,26,27,28,29,30]. Patients were blinded in 39 studies [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49], whereas outcome assessors were blinded in 25 studies [11,12,13,16,17,18,19,20,21,22,23,24,25,27,28,29,30,31,34,35,36,37,38,40,42].…”

Section: Resultsmentioning

confidence: 99%

“…Patients were blinded in 39 studies [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49], whereas outcome assessors were blinded in 25 studies [11,12,13,16,17,18,19,20,21,22,23,24,25,27,28,29,30,31,34,35,36,37,38,40,42]. Seven studies presented a clear explanation for withdrawals and dropouts in each group [12,13,15,16,24,25,33] (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Pharmacological and non-pharmacological intervention for rocuronium-induced withdrawal movement in the Korean population: a meta-analysis of 41 studies including 4,742 subjects

Choi

Lee

et al. 2014

Korean J Anesthesiol

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BackgroundWe purposed to systemically review studies investigating the prophylactic effect of both pharmacological and non-pharmacological modalities against rocuronium induced withdrawal movement (RIWM) in the Korean population.MethodsLiterature search was performed using MEDLINE, EMBASE, CENTRAL, Koreamed, KMBASE, KISS and RISS up to March 2014. Randomized controlled trials (RCTs) comparing pharmacological and non-pharmacological interventions with placebo aimed for the Korean population were included. Outcome measures were the incidence and severity of RIWM. We conducted subgroup analyses according to each intervention method.ResultsData were analyzed from 41 RCTs totaling 4,742 subjects. The overall incidence of RIWM was about 80% (range 56-100%). Incidence and severity of RIWM were significantly reduced with lidocaine (risk ratio [RR] 0.60, 95% CI 0.49-0.74; standardized mean difference [SMD] -0.74, 95% CI -1.05 to -0.44), opioids (RR 0.28, 95% CI 0.18-0.44; SMD -1.71, 95% CI -2.09 to -1.34) and hypnotics (RR 0.36, 95% CI 0.25-0.52; SMD -2.20, 95% CI -2.62 to -1.79). Regardless of tourniquet use, lidocaine showed a prophylactic effect against incidence and severity of RIWM: tourniquet (RR 0.36, 95% CI 0.21-0.62; SMD -1.51, 95% CI -2.15 to -0.86); non-tourniquet (RR 0.58, 95% CI 0.47-0.71; SMD -0.74, 95% CI -1.05 to -0.44). Dilution and slow injection of rocuronium decreased incidence and severity of RIWM: dilution (RR 0.47, 95% CI 0.39-0.56; SMD -1.64, 95% CI -2.47 to -0.81); slow injection (RR 0.34, 95% CI 0.17-0.70; SMD -2.13, 95% CI -2.74 to -1.51).ConclusionsThe greater part of pharmacological and non-pharmacological interventions showed prophylactic effect against the incidence and severity of RIWM in the Korean population.

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Section: Discussioncontrasting

confidence: 64%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Pharmacological and non-pharmacological intervention for rocuronium-induced withdrawal movement in the Korean population: a meta-analysis of 41 studies including 4,742 subjects

Choi

Lee

et al. 2014

Korean J Anesthesiol

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“…This is in agreement with the study by Lee et al . [ 24 ] who found similar results. No symptoms of muscle weakness were observed which may be compared with the findings of Abdulatif et al .…”

Section: Discussionsupporting

confidence: 58%

Effects of pretreatment with different neuromuscular blocking agents on facilitation of intubation with rocuronium: A prospective randomized comparative study

Shashank¹,

Singh²,

Singh³

2014

Indian J Anaesth

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Background and Aims:Priming principle refers to administration of a small dose of non-depolarising blocker, which when followed by a large intubating dose produces a relatively rapid and profound blockade to ensure suitable conditions for endotracheal intubation. We aimed to compare the effects of rocuronium, vecuronium, and atracurium as “pretreatment” drugs on intubating conditions with rocuronium facilitated endotracheal intubation.Methods:This double-blinded, randomised controlled prospective study was carried out at a tertiary health care hospital on patients undergoing surgical procedures under general anaesthesia. They were randomly allocated into three groups (n = 35) by computer generated randomisation chart to receive either rocuronium (0.06 mg/kg body weight) (Group A); vecuronium (0.01 mg/kg body weight) (Group B) or, atracurium (0.05 mg/kg body weight) (Group C), followed by intubating dose (0.6 mg/kg body weight) of rocuronium. The haemodynamic parameters and intubating conditions were studied and statistically analysed by ANOVA test and Student's t-test as applicable using statistical package for the social sciences 16.0 for windows (SPSS Inc., Chicago, IL, USA).Results:Excellent intubating conditions were noted in maximum number of patients in Group C (97.41%). No significant differences were observed in the systolic blood pressure in all the three groups at all-time intervals. The mean arterial pressure rose significantly from baseline value to maximum, at ‘0’ min in all the groups; however, no significant difference was observed amongst the groups (P > 0.05).Conclusion:Pretreatment with rocuronium bromide can facilitate endotracheal intubation in 60 s irrespective of non-depolarising muscle relaxants used for priming; however, it cannot attenuate haemodynamic changes associated with laryngoscopy and intubation.

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“…Therefore, various strategies to prevent the rocuroniuminduced pain response (RIPR) and RIWR such as the use of lidocaine [4, [10][11][12][13][14][15][16][17][18][19][20][21][22], opioids [4, 14,23], β-blockers [17], antihistamines [24], nitrous oxide (N 2 O) [12,25], magnesium sulfate (MgSO 4 ) [26], ketamine [20], and sodium bicarbonate (NaHCO 3 ) [27], as well as the dilution of rocuronium with normal saline [5] have been attempted and suggested by anesthesiologists.…”

Section: Introductionmentioning

confidence: 99%

Pharmacological interventions for preventing rocuronium-induced pain responses and rocuronium-induced withdrawal responses: a systematic review and network meta-analysis

2020

Signa Vitae

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Study objective: Rocuronium is widely used during the induction of general anesthesia. However, it is associated with rocuronium-induced pain response, which can appear as a rocuronium-induced withdrawal response. The purpose of this study was to compare the effectiveness of pharmacological interventions in preventing rocuronium-induced pain response and rocuronium-induced withdrawal response using a network meta-analysis. Design: Systematic review and network meta-analysis (NMA) of RCTs. Setting: Pharmacological interventions to prevent rocuronium-induced pain response and rocuronium-induced pain response and rocuronium-induced withdrawal. Data sources: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar were systematically searched from its inception until Mar 2020. Methods: We searched multiple databases and extracted randomized controlled trials that compared two or more pharmacological interventions to prevent rocuronium-induced pain response and rocuronium-induced withdrawal response in adult patients who received rocuronium injections for general anesthesia. We conducted network meta-analysis and used surface under the cumulative ranking curve values and rankograms to present the hierarchy of the pharmacological interventions evaluated. Results: In total, 43 studies (5,291 patients) were included in this network meta-analysis and 31 pharmacological interventions were evaluated. The rankogram and cumulative ranking plot showed that oxycodone followed by a combination of lidocaine and sodium bicarbonate (NaHCO3), esmolol, alfentanil, and rocuronium mixed with NaHCO3 had the lowest frequency of rocuronium-induced withdrawal response. In terms of rocuronium-induced pain response, NaHCO3 mixed with rocuronium showed the lowest frequency, followed by a combination of lidocaine and NaHCO3, a combination of lidocaine and nitrous oxide, rocuronium mixed with lidocaine, and lidocaine. Conclusions: Lidocaine administration has been shown to reduce the incidence of rocuronium-induced pain response regardless of the method of injection or drug combination. The combination of lidocaine and NaHCO3 or mixing NaHCO3with rocuronium was effective at reducing rocuronium-induced withdrawal response. In particular, oxycodone was shown to be more effective than the other opioids evaluated and esmolol was also found to be effective at reducing rocuronium-induced withdrawal response.

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Priming technique can alleviate the withdrawal responses associated with intravenous administration of rocuronium

Cited by 6 publications

References 25 publications

Pharmacological and non-pharmacological intervention for rocuronium-induced withdrawal movement in the Korean population: a meta-analysis of 41 studies including 4,742 subjects

Pharmacological and non-pharmacological intervention for rocuronium-induced withdrawal movement in the Korean population: a meta-analysis of 41 studies including 4,742 subjects

Effects of pretreatment with different neuromuscular blocking agents on facilitation of intubation with rocuronium: A prospective randomized comparative study

Pharmacological interventions for preventing rocuronium-induced pain responses and rocuronium-induced withdrawal responses: a systematic review and network meta-analysis

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