Recomendaciones sobre el uso de bloqueo neuromuscular profundo por parte de anestesiólogos y cirujanos. Consenso AQUILES (Anestesia QUIrúrgica para Lograr Eficiencia y Seguridad)

Errando, C.L.; Moreno-Sanz, Carlos; Vila-Caral, P.; Adana-Belbel, J.C. Ruiz de; Vázquez-Alonso, E.; Ramírez-Rodríguez, José Manuel; Veiga-Ruiz, G.; Guasch-Arévalo, E.; D'Ocón, Joaquín

doi:10.1016/j.redar.2016.08.002

Cited by 12 publications

(2 citation statements)

References 26 publications

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“…Acceleromyography is the standard neuromuscular block monitoring in clinical practice; it relies on the train-of-four nerve stimulation pattern recommendation: or the ratio of the fourth twitch to the first twitch T4/T1 ratio [ 11 ]. A train-of-four ratio of 0.7–0.9 is associated with impaired airway protective reflexes, upper airway obstruction, and postoperative hypoxemia [ 6 , 12 ]. Therefore, full recovery of neuromuscular function should be present at the time of tracheal extubations [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study

et al. 2023

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Introduction NMB facilitates intubating conditions in general anesthesia. However, it is associated with significant residual postoperative paralysis and morbidity. Objective To investigate the rate of underdiagnosed residual NMB based on two TOFR criteria (< 0.91 and < 1.00). Methods We performed a retrospective study adhering to STROBE guidelines. We included patients undergoing ENT surgery using single-dose neuromuscular block for balanced general anesthesia from June to December 2018. We collected demographic and anthropometric data, ASA score, NMBA dose, TOFR recordings at 5, 30 and 60 min and end of the surgery, anesthesia and surgery time, and administration of reversal agent. Statistical analysis included descriptive and dispersion measures statistics, curve and cross tables for residual NMB on different TOFR criteria with sub-analysis for AR, RR, and OR in patients over 65 years old. Results We included 57 patients, mean age 41; 43 females and 14 males. Mean anesthetic and surgical time were 139.4 and 116.1 min, respectively. All the patients received rocuronium under a mean ponderal single-dose of 0.48 mg/kg. Residual NMB rates were 29.9 and 49.1% for a TOFR < 0.91 and < 1.00, respectively. Older adults had an OR of 6.08 for residual NMB. Conclusions The rate of residual NMB was 29.9 to 49.1%, depending on the criteria used (TOFR < 0.91 and < 1.00, respectively). Patients above 65 years old had an increased risk of residual NMB (6.08 OR) and clinical symptoms related to residual NMB (11.75 OR). We recommend future research aiming to provide a specific surveillance protocol for patients above 65 years old, including shorter-action NMB, early reversal, and prolonged surveillance using the TOFR criteria of < 1.00 to identify patients at risk of residual NMB readily.

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Section: Introductionmentioning

confidence: 99%

Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study

et al. 2023

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“…[18][19][20] Thus, the recent recommendations stated that the reversal of neuromuscular blockade should be monitored using the monitoring devise. [21][22][23] However, in clinical situations, such a monitor is not frequently used for the assessment of neuromuscular blockade. 18,[24][25][26][27] Therefore, until the monitoring devise is available in every institution, it is necessary to develop a methodology for setting SDX dose that attains optimum reverse time (RT) with presently available data.…”

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confidence: 99%

Method for Prediction of Efficacy of Sugammadex Administered to Recover from Rocuronium-Induced Neuromuscular Blockade in Gynecological Laparoscopic Surgery Cases

Kimura

Omura²,

Hoshino³

et al. 2018

Biological & Pharmaceutical Bulletin

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Sugammadex (SDX), a neuromuscular blocking-reversal agent, quickly reverses neuromuscular blockade induced by rocuronium (RCR). SDX dosage is set according to the state of neuromuscular blockade determined with a neuromuscular monitoring device. However, in clinical situations, such a devise is not frequently used. Here, we report construction of a method for theoretically setting SDX dose by which the optimum reverse time (RT) can be obtained for individual patients even when the device is not available. The subjects were 42 adult female patients who underwent laparoscopic surgery from 1 August 2015 to 31 March 2016, during which RCR and SDX were administered. We formulated an equation for theoretically calculating the RCR residual ratio (RR) in blood after SDX administration. Furthermore, we examined the relationship between RR and RT. Based on the results obtained, we developed a method for predicting RT using RR. We excluded 1 subject as the RT value was detected as an outlier in our analysis. Multiple regression analysis was performed using standard body weight, serum creatinine, total bilirubin, and RR as explanatory variables. The number of subjects with a prediction error of RT within 1 min was 36 (87.8%) of 41 in multiple regression analysis. We could predict RT following SDX administration by using the RT prediction expression with RR obtained for subjects administered RCR during the surgery. Furthermore, our results suggest that the SDX dose able to achieve optimum RT may be set prior to surgery on the basis of the present methodology.Key words sugammadex; rocuronium; gynecological laparoscopic surgery; reverse time prediction It has been reported that the period of hospitalization could be reduced, and patient QOL and surgical results improved by use of laparoscopic surgery as compared to a laparotomy in the field of gynecology.1-3) With laparoscopic surgery, use of a neuromuscular blocking agent is required for expanding the surgical field and preventing sudden body motion.4) Rocuronium (RCR), a widely used neuromuscular blocking agent, is known to have a reduced bradycardia effect 5) when used for gynecological laparoscopic surgery and less bioaccumulation because an active metabolite is absent, 5,6) and a significantly shorter time of onset of action is available and reduced time for completing tracheal intubation can be achieved.6-14) Meanwhile, at the completion of the surgery, sugammadex (SDX) is often used as a neuromuscular blocking-reversal agent for shortening the time of recovery from muscle relaxation and preventing a residual relaxation effect.15) SDX, a derivative of γ-cyclodextrin, has also be reported to reverse neuromuscular blockade more quickly and safety than conventional cholinesterase inhibitors by forming an inclusion compound with RCR in blood to reduce the concentration of the neuromuscular blocking agent in the neuromuscular junction. 16,17) The dose of SDX is set according to the state of neuromuscular blockade producing muscle relaxation, which can be determined with a neu...

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Are There New Evidences on the Use of Neuromuscular Blocking Agents and Reversal Drugs in Thoracic Surgery?

Errando

Ayas

García-Villalobos

2020

Anesthesia in Thoracic Surgery

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Recomendaciones sobre el uso de bloqueo neuromuscular profundo por parte de anestesiólogos y cirujanos. Consenso AQUILES (Anestesia QUIrúrgica para Lograr Eficiencia y Seguridad)

Cited by 12 publications

References 26 publications

Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study

Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study

Method for Prediction of Efficacy of Sugammadex Administered to Recover from Rocuronium-Induced Neuromuscular Blockade in Gynecological Laparoscopic Surgery Cases

Are There New Evidences on the Use of Neuromuscular Blocking Agents and Reversal Drugs in Thoracic Surgery?

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