Comparison of Rocuronium, Succinylcholine, and Vecuronium for Rapid-sequence Induction of Anesthesia in Adult Patients

Magorian, Toni; Flannery, K. B.; Miller, Ronald D.

doi:10.1097/00000542-199311000-00007

Cited by 406 publications

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“…3 Re-appearance of T1 in the present case was at 64 min, and the duration of action was not noticeably shortened. This outcome is not consistent with Cammu et al's results, 2 and the difference might be due to the anesthetics used.…”

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confidence: 41%

Repeat dosing of rocuronium after reversal of neuromuscular block by sugammadex

Matsuki

Takahata

Iwasaki

2011

Can J Anesth/J Can Anesth

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To the Editor, Sugammadex specifically antagonizes the steroidal neuromuscular blocking agent (NMBA), rocuronium, 1 and it also has affinity for other steroidal NMBAs. A period of 24 hr is currently recommended before re-administering rocuronium after sugammadex. A If neuromuscular block (NMB) is needed before this time interval ends, a nonsteroidal NMBA should be given; however, nonsteroidal NMBAs are not available clinically in Japan. We present herein a 35-yr-old male patient (weight 73 kg, height 173 cm) in whom NMB was achieved using rocuronium 19 min after administering sugammadex. The authors have obtained agreement from the patient for submission of this case report to a medical journal.The patient was scheduled for elective parotidectomy, and his preoperative blood chemistry was within normal limits. Anesthesia was induced with propofol, and endotracheal intubation was facilitated using rocuronium 40 mg. Maintenance of anesthesia was achieved with sevoflurane, remifentanil, and fentanyl. Repetitive train-of-four (TOF) stimulation was applied at the ulnar nerve using a TOF Watch (Organon Ltd, Dublin, Ireland) monitor. Rocuronium 10 mg was added every 30-40 min, for a total dose of 100 mg over 204 min. At the end of surgery, 60 min after rocuronium, sugammadex 200 mg (2.75 mgÁkg -1 ) was administered, and the patient's trachea was extubated.After that, bleeding from the drainage tube and progressive bulging of the surgical field were observed. The otolaryngologists requested immediate re-exploration for hemostasis. We prepared to monitor NMB at the adductor pollicis muscle using a TOF-WatchÒ SX with preload (the Hand Adapter, Organon, Oss, the Netherlands), and we obtained digitized data. Anesthesia was induced with propofol, remifentanil, and sevoflurane inhalation, and neuromuscular blockade was monitored throughout the second surgery. Peripheral skin temperature, measured at the thenar eminence of the palm, was maintained at 32.5-34.5°C, and body temperature was maintained at 36.2-37.2°C.Rocuronium 70 mg was administered 19 min after sugammadex, but the first twitch to TOF stimulation (T1) did not disappear 195 sec after this dose so an additional 30 mg was added (Figure). The first twitch disappeared 105 sec after the second dose, for an onset time of 300 sec. Anesthesia was maintained using sevoflurane, remifentanil, and fentanyl.A single response following post-tetanic stimulation (post-tetanic count) was observed 50 min after rocuronium, and T1 appeared at 64 min. At the end of the second surgery, sugammadex 150 mg was again administered when the train-of-four ratio was 16%. The train-of-four ratio reached 102% within 150 sec, and the patient's trachea was extubated ( Figure).Cammu et al. examined the onset and duration of re-administration of 1.2 mgÁkg -1 rocuronium after sugammadex 4.0 mgÁkg -1 under propofol anesthesia in healthy volunteers. 2 They found that sugammadex prolongs the onset time of rocuronium when the time interval from sugammadex administration was \25 min. Our patient was given ...

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supporting

confidence: 41%

Repeat dosing of rocuronium after reversal of neuromuscular block by sugammadex

Matsuki

Takahata

Iwasaki

2011

Can J Anesth/J Can Anesth

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“…2'1~ Cooper et al ~8 reported onset times of 60.4 (22.4) and 88.9 (36.9) sec (mean (SD)), respectively, after succinylcholine 1.0 mg. kg -l and rocuronium 0.6 mg. kg -I in patients anaesthetized with thiopentone, fentanyl and nitrous oxide in oxygen. Similarly, Magorian et al 2 reported onset times of 50 (17) and 89 (33) sec (mean (SD)) after succinylcholine 1.0 mg-kg -~ and rocuronium 0.6 mg. kg -1, respectively.…”

Section: Discussionmentioning

confidence: 76%

Different priming techniques, including mivacurium, accelerate the onset of rocuronium

Naguib

1994

Can J Anaesth

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“…Esta independencia de la dosis del índice de recuperación en relación a la fórmula de cálculo de la dosis ha sido descrita en la literatura 31 . Es destacable que la duración del índice de recuperación en nuestros pacientes fue el doble de lo descrito por Leykin 26 y en general más prolongado que lo descrito en la literatura [29][30][31] , asemejándose al de los bloqueadores neuromusculares de larga duración 31 .…”

Section: Discussionunclassified

Rocuronio en obesos: ¿Debe dosificarse por peso real o peso ideal?

Ojeda¹,

Gazabatt²,

Bustamante³

et al. 2014

Rev Chil Anest

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resumenEl aumento universal en la prevalencia de obesidad ha causado que los anestesiólogos se vean frecuentemente enfrentados a anestesiar pacientes obesos. Pese a esto aún existen dudas respecto a cómo dosificar las drogas en estos pacientes. La literatura recomienda dosificar el rocuronio en obesos en base al peso ideal (IBW, iniciales del inglés Ideal Body Weight) pero esta sugerencia está basada más bien en la prudencia que en la evidencia. Se decidió explorar con análisis de sobrevida (análisis tiempo-evento), la duración del rocuronio en obesos al ser dosificado por peso ideal (IBW) y por peso real (TBW, iniciales del inglés de peso corporal total). Al administrar el rocuronio en base al peso real (TBW) se observó una prolongación en su duración de acción con un acortamiento de su latencia en relación con la dosificación en base al peso ideal (IBW). Hubo una marcada prolongación de la duración de acción y el índice de recuperación tanto al dosificar por peso real como peso ideal. Debido a esta sensibilidad aumentada al rocuronio en pacientes obesos recomendamos dosificarlo en base al peso ideal, excepto si se necesita intubar rápidamente. AbstractThe universal increase in prevalence of obesity has caused that anesthesiologist are frequently encountered with anesthetizing obese patients. There stills exists doubt on how to dosage drugs to these patients. Literature recommends dosing rocuronium in the obese based on ideal weight (IBW), being this suggestion based more on prudence than on evidence. Randomized control trial was designed for obese patients scheduled for bariatric surgery to study the pharmacodynamics of rocuronium in this population. Patients were randomly assigned into two groups: rocuronium dosage 0.6 mg·kg -1 for real weight (TBW) or rocuronium dosage of 0.6 mg·kg -1 for ideal weight (IBW). Ideal weight was calculated according to Lemmens formula. The reference group was the dosage based on IBW. Previous calibration, evaluating the first twitch of train-of-four (T 1 ), we registered onset time, clinical duration, recovery index, level of muscle relaxation to which the first reinforcement was administered and clinical duration of rocuronium reinforcement. A total of 100 patients were part of the study: 54 in group TBW and 46 in group IBW. When administering rocuronium based on real weight (TBW) a prolongation in clinical duration was found: Medium (IQR*); 79.5 (67 -105) minutes versus 44.5 (33 -63.5 minutes) in the IBW group (p < 0.001) with a decrease in latency in the TBW group 120 (90-150 secs.) versus the IBW group 180 (120 -270 secs.) (p < 0.001). There were no differences in the recovery index between both levels of dosing. There was a marked prolongation of both clinical duration and recovery index in both groups, as supported in some literature. Based on the evidence, we recommend to dose rocuronium in obese patients based on ideal weight, with the exception of cases were quick intubation is required.* IQR = interquartile range.

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Comparison of Rocuronium, Succinylcholine, and Vecuronium for Rapid-sequence Induction of Anesthesia in Adult Patients

Cited by 406 publications

References 0 publications

Repeat dosing of rocuronium after reversal of neuromuscular block by sugammadex

Repeat dosing of rocuronium after reversal of neuromuscular block by sugammadex

Different priming techniques, including mivacurium, accelerate the onset of rocuronium

Rocuronio en obesos: ¿Debe dosificarse por peso real o peso ideal?

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