Comparison of the variability of the onset and recovery from neuromuscular blockade with cisatracurium versus rocuronium in elderly patients under total intravenous anesthesia

Background:The importance of the characteristics of anesthesia and postoperative residual curarization (PORC) in the elderly population should be a growing concern in this century. Aims: To investigate the effect of sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization in the young elderly and middle-aged elderly patients who underwent elective laparoscopic cholecystectomy, followed by a train of four (TOF) watch monitorization. Study Design: Prospective clinical trial study. Methods: Sixty patients over the age of 65 with American Society of Anesthesiologists I-III were divided into two groups according to their age (65-74 years old and ≥75 years old). Patients received sugammadex (2.0 mg/ kg iv) at the reappearance of the second twitch of the TOF as an agent for reversal of neuromuscular blockage at the end of surgery. Patients were extubated at the time of TOF ≥0.9. The patients' TOF responses were evaluated with regards to PORC in at the 5th minute and were followed up for one hour in the recovery room. Reintubation was applied for those patients who developed PORC and had peripheric oxygen saturation <90% despite being given 6 L oxygen per min with a face mask. Results: The onset time of neuromuscular blocking agent and time from T 2 to achieve TOF ratio 90% (the duration of sugammadex effect) or over were found to be longer in the middle-aged elderly group than in the young elderly group. A statistically significant relationship was found between age and the duration of TOF ratio to reach 0.9 in the same direction. The PORC incidence and rate of reintubation were found to be 1.7% in all patients. Conclusion: In our opinion, it is necessary to remember that the duration of sugammadex effect on the recovery period is prolonged for patients who are aged ≥75 years compared to patients aged between 65-74 years. (ClinicalTrials.gov Identifier: ACTRN12615000758505) Keywords: Elderly, postoperative residual curarization, reintubation, sugammadex Young elderly people, middle-aged elderly people, and old elderly people have been classified, respectively, between 65-74 years of age, between 75-84 years of age, and over age 84 by gerontologists (1). A number of studies have indicated that the prevalance of postoperative residual curarization (PORC) increases with age (2,3).The principle of train of four (TOF) Watch was to indicate a pattern of stimulation that did not require the comparison of evoked responses to a control response obtained before administration of a neuromuscular blocking agent (NMBA). As well as enabling the observer to compare T 1 (first twitch of the TOF) to T 0 (control), it also enables comparison of T 4 (fourth

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“…A number of studies have indicated that the prevalance of postoperative residual curarization (PORC) increases with age (2,3).…”

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confidence: 99%

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

Yazar¹,

Yılmaz²,

Bilgin³

et al. 2016

Balkan Med J

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“…This feature was already demonstrated in the study by Xiaobo et al . [ 9 ]. Comparing rocuronium versus cisatracurium in a prospective randomized trial including 80 patients under total intravenous anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…TOF variability: It was defined by the changes in the TOF responses between the different interval times within the paralysis period and recovery time. This would gauge the stability of the paralysis or decurarization over time [ 9 ]. Tolerance: Hemodynamic tolerance was defined by a significant variation in heart rate above 30% from the baseline value and/or a significant drop of systolic and/or diastolic blood pressures above 30% from the baseline values.…”

Section: Methodsmentioning

confidence: 99%

“…Neuromuscular Blocking Agents (NMBAs) are usually used in patients with altered respiratory mechanics properties such as Acute Respiratory Distress Syndrome (ARDS), status asthmaticus or severe acute exacerbation of COPD (AECOPD) [ 6 , 7 ]. Only few products exhibit the so called ideal Neuromuscular Blockade (NMB) effect which is influenced by several factors namely, required speed of onset and offset, cardiovascular stability, possible accumulation of the NMBA metabolites, elimination routes, and costs [ 8 , 9 ]. One of these products is cisatracurium which is a non-depolarizing NMBA, a benzylisoquinolinium like atracurium, doxacurium, and mivacurium [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Compared efficacy and tolerance of the neuromuscular blockade induced by brand-name (Nimbex®) and generic (Cisatrex®) of cisatracurium in mechanically ventilated critically ill patients: a crossover double-blind randomized study

et al. 2020

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Introduction use of generic drugs is common. However, there is still concern among patients and physicians that brand name drugs are more efficient. The aim of the study was to compare efficacy and tolerance between two forms of cisatracurium: brand name versus generic name. Methods it´s a crossover, randomized, double-blind physiological trial. Patients admitted for hypoxemic acute respiratory failure with PaO2/FIO2 < 200mmHg despite optimized ventilation and sedation thus requiring non-depolarizing neuromuscular blocking agents (NMBAs), were enrolled. Patients received consecutively, in a random order, cisatracurium brand name (Nimbex®) and generic (Cisatrex®) over two-hour period separated by one-hour washout period. Neuromuscular function was monitored by a calibrated train-of-four (TOF) stimulation device. Paralysis time delay to reach TOF of 2/4, recovery kinetics and tolerance were monitored. The number needed to demonstrate a significant difference in time delays to reach a TOF of 2/4 between the two forms of cisatracurium was estimated at 22 patients. Results twenty-two patients were included. Eight (36.4%) had acute respiratory distress syndrome; 8(36.4%), acute exacerbation of chronic obstructive pulmonary disease and 3(13.6%), status asthmaticus. Median [IQR] SAPS II at admission, 28.5 [22, 41]. PaO2/FIO2, 121 [81, 156] mmHg. Paralysis time delays were respectively, 80 [50, 112] vs. 87 [65, 115] minutes, in Nimbex® group and Cisatrex® group; (p=0.579). Within the recovery period, the between two-studied drugs´ difference in TOF was at 0.25±0.96; p=0.64. There were no significant hemodynamic differences. Conclusion the present study revealed no significant differences in efficacy nor in tolerance between cisatracurium brand name Nimbex® and generic name Cisatrex® in hypoxemic ventilated patients.

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“…[5][6][7][8] In our study, there was no significant difference in the onset times and in time taken for the maximum block between the young and the elderly control group. Xiaobo et al 9 concluded that the time of onset was comparable between the elderly and adult patients receiving cisatracurium or rocuronium. This is most likely a reflection of multiple factors.…”

Section: Effect Of Age On Rocuronium Neuromuscular Blockmentioning

confidence: 99%

Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure

Pradeep¹

2016

Journal of Research &Amp; Innovation in Anesthesia

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Context The duration of neuromuscular block with rocuronium is affected by old age as well as renal impairment. It would be helpful for anesthetists to know the variation in the block in elderly patients with renal failure and the significance of neuromuscular monitoring in this group. Aim The aim of our study is to investigate the neuromuscular effects of 0.6 mg/kg rocuronium under general anesthesia in young adults and elderly patients with or without renal failure. Study design Prospective randomized controlled study. Materials and methods Young and elderly 100 patients were divided into 4 groups of 25 each, with or without renal failure. General anesthesia with propofol 2 mg kg intravenous (iv), fentanyl 2 μg kg iv, and 60% N2O in O2 were given. Neuromuscular monitoring was started immediately after the induction of anesthesia and before the administration of muscle relaxant. After the stabilization of control responses, 0.6 mg kg rocuronium was injected intravenously. The onset time, time to achieve maximum block, and the recovery times were noted. Statistical analysis used The statistical analysis of the data from the study was performed with the Statistical Package for the Social Sciences (SPSS) software for Window Release 14.0. One-way analysis of variance, Bonferroni's, and chi-square test were used to compare patients’ characteristics. Results The duration of block as well as the recovery indices were significantly prolonged in the elderly compared to the young patients. Maximum prolongation was observed in the elderly group with renal failure. This underlines the importance of neuromuscular monitoring in these patients. How to cite this article Gvalani SK, Pradeep L. Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure. Res Inno in Anesth 2016;1(2):45-51.

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Comparison of the variability of the onset and recovery from neuromuscular blockade with cisatracurium versus rocuronium in elderly patients under total intravenous anesthesia

Cited by 17 publications

References 21 publications

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

Compared efficacy and tolerance of the neuromuscular blockade induced by brand-name (Nimbex®) and generic (Cisatrex®) of cisatracurium in mechanically ventilated critically ill patients: a crossover double-blind randomized study

Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure

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