The effects of age on maintenance of intense neuromuscular block with rocuronium

Furuya, Takeshi; Suzuki, Takahiro; Kashiwai, Akihiro; Konishi, Junpei; Aono, M; Hirose, Noriya; Kato, Jitsu; Ogawa, Setsuro

doi:10.1111/j.1399-6576.2011.02605.x

Cited by 25 publications

(14 citation statements)

References 12 publications

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“…However, when the two groups were compared, it was revealed that it was greater for vecuronium than cisatracurium. Similarly, the duration of intensive block after a single intubation dose of rocuronium had a wider range in patients over 70 years of age than it did in younger subjects, between the ages of 20−60 [24].…”

Section: Benzylisoquinoline Derivativesmentioning

confidence: 90%

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Blokada nerwowo-mięśniowa u osób w podeszłym wieku

Stankiewicz-Rudnicki

2016

Anaesthesiol Intensive Ther

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The aim of the presented review is to highlight the clinical problem of postoperative residual curarization (PORC) following general anaesthesia in the elderly. Possible complications of PORC are described along with age-induced changes in pharmacokinetics of long and intermediate-acting neuromuscular blocking agents. This is intended to facilitate the selection and to promote appropriate intraoperative use of muscle relaxants in patients over the age of 65 years.Key words: elderly patients; neuromuscular block, muscle relaxants; neuromuscular block, reversal; postoperative residual curarization Anaesthesiology Intensive Therapy 2016, vol. 48, no 4, 257-260 Anaesthesiologists are regularly involved in the treatment of elderly patients due to the increasing life expectancy and rising number of surgeries in the aging population [1]. General anaesthesia comprises four crucial components: unconsciousness, analgesia, immobilization and haemodynamic stability [2]. Neuromuscular block serves the two latter purposes. As it maintains good surgical conditions as well as facilitating airway management, doses of both volatile and intravenous anaesthetics can be considerably reduced. This is of importance in patients over 65 years of age, particularly those older than 75. This group of patients is most susceptible to the adverse effects of anaesthetics [3], including decreased heart muscle contractility and hypotension, which pose a risk of cardiac and central nervous system ischaemia [4].Unfortunately, advanced age is accompanied by an increasing risk of postoperative residual curarization (PORC) [5] which, along with intraoperative awareness [6], is one of the most clinically significant complications of the use of muscle relaxants. Residual blockade is currently defined by the train of four ratio (TOFR) < 0.9, although previous reports mentioned TOFR < 0.7. It may lead to severe respiratory complications in the post-operative period [7], and thus prolong hospitalization. Awareness of the specific issues of neuromuscular blocking agents use in the elderly is therefore crucial in daily anaesthesiological practice. CliniCal aspeCts of the pharmaCokinetiCs of neuromusCular bloCking agents in the elderlyDoses of both steroid and benzylisoquinoline-derived non-depolarising muscle relaxants necessary to reach maximal block, i.e. 95% reduction of muscle response to a stimulus (effective dose 95 , ED 95 ), do not vary significantly between elderly persons and younger subjects [8,9]. This suggests that the physiology of the neuromuscular junction and the pharmacodynamics of neuromuscular blocking agents are not markedly altered in advanced age. It is the pharmacokinetics of these agents that is responsible for their altered clinical effects in the elderly.Decreased cardiac output is accompanied by reduced skeletal muscle perfusion [3] and, consequently, one should expect a prolonged time to maximum blockade following drug administration [10,11]. However, doses of muscle relaxants used for intubation are two to three, or ...

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Section: Benzylisoquinoline Derivativesmentioning

confidence: 90%

“…mean time to response to a single stimulation preceded with tetanic stimulus, i.e. a post-tetanic count (PTC) = 1 [24].…”

Section: Aminosteroidsmentioning

confidence: 99%

Blokada nerwowo-mięśniowa u osób w podeszłym wieku

Stankiewicz-Rudnicki

2016

Anaesthesiol Intensive Ther

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“…First, there is an increase in the duration of action of rocuronium with age. A study conducted by Furuya et al concluded that the duration of time taken for the appearance of posttetanic count (PTC) was twofold longer and variable in older as compared to younger individuals [11]. Secondly, there is a prolongation of rocuronium action in the female gender as compared to males [12].…”

Section: Discussionmentioning

confidence: 99%

Management of Residual Neuromuscular Blockade Recovery: Age-Old Problem with a New Solution

Green

Venkatesh

Venkataramani

2017

Case Reports in Anesthesiology

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Neostigmine has been traditionally used as the agent of choice to reverse Neuromuscular Blockade (NMB) after muscle paralysis during general anesthesia. However, the use of neostigmine has not been without untoward events. Sugammadex is a novel drug that selectively binds to aminosteroid nondepolarizing muscle relaxants and reverses even a deep level of NMB. Controversy exists regarding the optimal dose of sugammadex that is effective in reversing the NMB after the incomplete reversal with neostigmine and glycopyrrolate. We discuss a case where sugammadex reduced the time of the recovery from NMB in a patient who had incomplete antagonisms following adequate treatment with neostigmine, aiding timely extubation without persistent residual NMB, and hence prevented the requirement of postoperative ventilation and the improvement in patient care. More randomized control studies are needed in order to conclude the appropriate dose of sugammadex in cases of incomplete reversal.

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“… 29 This prolongation may be as much as a twofold increase, from 31 minutes in younger patients to 51 minutes in the elderly. 37 Therefore, in elderly patients, extra doses should be administered with care, only after the reappearance of train-of-four response.…”

Section: Pharmacology Of Nmbas In the Elderlymentioning

confidence: 99%

“…Variations in body habitus and composition of the body of the elderly may result in an overdosing due to the altered pharmacokinetics of NMBAs caused by, as previously mentioned, increased fat, decreased muscle mass, and lower Vd. 37 …”

Section: Pharmacology Of Nmbas In the Elderlymentioning

confidence: 99%

Neuromuscular blockade in the elderly patient

Lee

Athanassoglou

Pandit

2016

JPR

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Neuromuscular blockade is a desirable or even essential component of general anesthesia for major surgical operations. As the population continues to age, and more operations are conducted in the elderly, due consideration must be given to neuromuscular blockade in these patients to avoid possible complications. This review considers the pharmacokinetics and pharmacodynamics of neuromuscular blockade that may be altered in the elderly. Compartment distribution, metabolism, and excretion of drugs may vary due to age-related changes in physiology, altering the duration of action with a need for reduced dosage (eg, aminosteroids). Other drugs (atracurium, cisatracurium) have more reliable duration of action and should perhaps be considered for use in the elderly. The range of interpatient variability that neuromuscular blocking drugs may exhibit is then considered and drugs with a narrower range, such as cisatracurium, may produce more predictable, and inherently safer, outcomes. Ultimately, appropriate neuromuscular monitoring should be used to guide the administration of muscle relaxants so that the risk of residual neuromuscular blockade postoperatively can be minimized. The reliability of various monitoring is considered. This paper concludes with a review of the various reversal agents, namely, anticholinesterase drugs and sugammadex, and the alterations in dosing of these that should be considered for the elderly patient.

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The effects of age on maintenance of intense neuromuscular block with rocuronium

Cited by 25 publications

References 12 publications

Blokada nerwowo-mięśniowa u osób w podeszłym wieku

Blokada nerwowo-mięśniowa u osób w podeszłym wieku

Management of Residual Neuromuscular Blockade Recovery: Age-Old Problem with a New Solution

Neuromuscular blockade in the elderly patient

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