Rocuronium priming for tracheal intubation in COVID‐19 patients

Hoshijima, Hiroshi; Nagasaka, Hiroshi; Ozaki, Masayuki; Komiyama, Kenichiro; Mieda, Tsutomu; Nakamura, Chiaki; Doi, Kouki

doi:10.1002/anr3.12060

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…Likewise, the report by Oon and Ha discusses the balance between staff safety and patient experience, which were both positive in this case [5]. The symptoms of COVID‐19 were also described, including Hoshijima et al's description of a severely hypoxic but only minimally symptomatic patients, experiencing what has come to be known as silent or ‘happy’ hypoxia [10, 11].…”

Section: The Patient Experience Of Covid‐19mentioning

confidence: 91%

“…. induction to tracheal intubation in patients with COVID-19, using a modified version of existing recommendations [10]. Ahmad et al described one of the first cases of awake tracheal intubation in COVID-19 and described various modifications to standard practice in order to safeguard staff safety [17].…”

Section: Tully Et Al [14]mentioning

confidence: 99%

“…Innovation occurred likewise in the clinical setting to adapt common techniques in response to challenges presented by COVID‐19. Hoshijima et al report the technique of rocuronium priming to minimise the time from induction to tracheal intubation in patients with COVID‐19, using a modified version of existing recommendations [10]. Ahmad et al described one of the first cases of awake tracheal intubation in COVID‐19 and described various modifications to standard practice in order to safeguard staff safety [17].…”

Section: Anaesthetists As Innovatorsmentioning

confidence: 99%

See 2 more Smart Citations

Case reports in the COVID‐19 pandemic: first responders to an emergency in evidence‐based medicine

Kearsley

Guris

Miles

et al. 2021

Anaesthesia Reports

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Section: The Patient Experience Of Covid‐19mentioning

confidence: 91%

Section: Tully Et Al [14]mentioning

confidence: 99%

Section: Anaesthetists As Innovatorsmentioning

confidence: 99%

See 1 more Smart Citation

Case reports in the COVID‐19 pandemic: first responders to an emergency in evidence‐based medicine

Kearsley

Guris

Miles

et al. 2021

Anaesthesia Reports

View full text Add to dashboard Cite

“…Preoxygenation proved paramount in this vulnerable population and was accomplished with either high-flow nasal cannula or BiPAP [ 6 ]. After preoxygenation for at least 3 min, this group proceeded with modified rapid sequence induction using midazolam (1–2 mg) for those extremely anxious patients and lidocaine (> 1.5 mg/kg) to suppress coughing [ 15 ]. Etomidate (0.2–0.3 mg/kg) was used for induction for those with hemodynamic instability or propofol (1–1.5 mg/kg) for those with stable hemodynamics.…”

Section: Indications and Methodsmentioning

confidence: 99%

“…On the other hand, in an effort to shorten the time to onset of neuromuscular blockade, a priming dose of rocuronium has been described when intubating patients with COVID-19 [ 15 ]. Utilizing 0.03–0.04 mg/kg rocuronium 3 min before intubating, Hoshijima et al [ 15 ] evaluated this technique when intubating patients with COVID-19. Not surprisingly, these patients became hypoxic with oxygen saturations as low as 55% prior to securing the airway as even low levels of neuromuscular blockade proved deleterious to patients with COVID-19 prior to intubation.…”

Section: Indications and Methodsmentioning

confidence: 99%

Neuromuscular blockade management in patients with COVID-19

Chaves-Cardona

Hernandez-Torres

Kiley

et al. 2021

Korean J Anesthesiol

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This narrative review evaluates the evidence for using neuromuscular blocking agents (NMBA) in patients being treated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While large prospective randomized-controlled trials (RCTs) are lacking at this point in time, smaller observational studies and case series are reviewed to ascertain the indications and utility of NMBAs. Additionally, large RCTs that address similar clinical scenarios are reviewed and the authors translate these findings to patients with COVID-19. Specifically, NMBAs can be helpful during endotracheal intubation to minimize the risk of patient coughing and possibly infecting healthcare personnel. NMBAs can also be used in patients to promote patient-ventilator synchrony while reducing the driving pressure needed with mechanical ventilation, particularly in patients with the severe clinical presentation (Type H phenotype). Prone positioning has also become a cornerstone in managing refractory hypoxemia in patients with SARS-CoV-2 acute respiratory distress syndrome (ARDS), and NMB can be useful in facilitating this maneuver. In the perioperative setting, deep levels of neuromuscular blockade can improve patient outcomes during laparoscopic operations and may theoretically reduce the risk of aerosolization as lower insufflation pressures may be utilized. Regardless of the indication, quantitative neuromuscular monitoring remains the only reliable method to confirm adequate recovery following cessation of neuromuscular blockade. Such monitors may serve a unique purpose in patients with COVID-19 as automation of measurements can reduce healthcare personnel -patient contact that would occur during periodic subjective evaluation with a peripheral nerve stimulator.

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Rocuronium bromide

2021

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Rocuronium bromide Hypoxia: 2 case reportsIn a case series, a 67-year-old woman and 67-year-old man were described, who developed hypoxia during treatment with rocuronium bromide for tracheal intubation [routes not stated].Patient 1: The 67-year-old woman was admitted to the infectious disease ward following diagnosed with Coronavirus disease-19 (COVID-19). Four days later, regardless of the administration of 10 L/min oxygen via facemask, her arterial oxygen saturation was found to be 85%. She did not have respiratory distress and she was alert and orientated. Due to deterioration in her condition, a decision was made to intubate her trachea and ventilate her lungs. Therefore, ECG, noninvasive blood pressure and pulse oximetry monitoring were established. She was pre-oxygenated with 5 L/min oxygen for 5 minutes, which resulted in her arterial oxygen saturations reached 92%. Thereafter, she was started on rocuronium bromide [rocuronium] 2mg as a priming dose. Approximately, 3 minutes later, her oxygen saturation decreased to 80% without any diplopia. Immediately, she was administered with propofol for induction of general anaesthesia followed by rocuronium bromide 48mg to facilitate tracheal intubation [received a total dose of 0.95 mg.kg -1 ]. However, her oxygen saturation further decreased to 70%. Meanwhile, she was manually ventilated for approximately 3 minutes, which resulted in her oxygen saturation reached 95%. Later, she was intubated by a skilled front-line anaesthetist. Consequently, she was haemodynamically stable throughout the tracheal intubation procedure.Patient 2: The 67-year-old man was admitted to the infectious disease ward following diagnosed with Coronavirus disease-19 (COVID-19). Eight days later, his condition worsened and a decision of trachea intubation was made. Therefore, he was maintained on the arterial oxygen saturation of approximately 90% by administering 10 L/min of oxygen via facemask. He was alert and orientated without respiratory distress. Therefore, ECG, noninvasive blood pressure and pulse oximetry monitoring were established. He was pre-oxygenated with 5 L/min oxygen for 5 minutes, which resulted in his arterial oxygen saturations reached 92%. Thereafter, he was started on rocuronium bromide [rocuronium] 2mg as a priming dose. Approximately, 3 minutes later, his oxygen saturation decreased to 80%. Diplopia was not reported, but respiratory depression was observed. Immediately, he was administered with propofol for induction of general anaesthesia followed by rocuronium bromide 48mg to facilitate tracheal intubation [received a total dose of 0.67 mg.kg -1 ]. However, after approximately 60 seconds, his arterial oxygen saturation further decreased to 55%. Therefore, he proceeds directly to tracheal intubation by a skilled anaesthetist. Thereafter, he was haemodynamically stable throughout the procedure.

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Rocuronium priming for tracheal intubation in COVID‐19 patients

Cited by 3 publications

References 12 publications

Case reports in the COVID‐19 pandemic: first responders to an emergency in evidence‐based medicine

Case reports in the COVID‐19 pandemic: first responders to an emergency in evidence‐based medicine

Neuromuscular blockade management in patients with COVID-19

Rocuronium bromide

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