Dilution and slow injection reduces the incidence of rocuronium-induced withdrawal movements in children

Abstract

BackgroundThe aim of this study was to evaluate whether slow injection of diluted rocuronium could reduce rocuronium-induced withdrawal movements effectively in children.MethodsAfter loss of consciousness, rocuronium 0.6 mg/kg was administered into 171 children according to the pre-assigned groups as follows: Group CF, injection of non-diluted rocuronium over 5 seconds; Group CS, injection of non-diluted rocuronium over 1 minute; Group DF, injection of diluted rocuronium (10 times) over 5 seconds; Group DS, injection of diluted rocuronium over 1 minute. An investigator who was blind to the injection techniques recorded patient movements followed by rocuronium injection.ResultsThe incidence of withdrawal movement in Group CF was highest among the groups (all P < 0.0001). Moreover, withdrawal movement was less frequently observed in Group DS than in Groups CS and DF (P = 0.021 and P = 0.007, respectively).ConclusionsSlow injection of diluted rocuronium reduced the incidence of withdrawal movements in children.

The Efficacy of Antipyretic Analgesics Administration Intravenously for Preventing Rocuronium-Associated Pain/Withdrawal Response: A Systematic Review and Meta-Analysis

“…Rocuronium has a PH of 4.0, and dilution could reduce injection pain [25], which may explain the injection pain of it [26]. Blunk and Seifert [27] Injecting lidocaine was reported the best intervention to prevent RAIPWR [21], and we found AAs also took effect.…”

Pharmacological and non-pharmacological intervention for rocuronium-induced withdrawal movement in the Korean population: a meta-analysis of 41 studies including 4,742 subjects

“…Thirteen studies mentioned the method of random sequence generation [11,12,13,14,15,16,17,18,19,20,21,22,23], and 10 studies used allocation concealment [11,14,23,24,25,26,27,28,29,30]. Patients were blinded in 39 studies [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49], whereas outcome assessors were blinded in 25 studies [11,12,13,16,17,18,19,20,21,22,23,24,25,27,28,29,30,31,34,35,36,37,38,40,42].…”

The efficacy of Antipyretic Analgesics administration intravenously for Preventing Rocuronium-Associated Pain/Withdrawal Response: a systematic review and meta-analysis

“…Arndt and Klement [24] reported that peripheral veins were invested with polymodal nociceptors, which released endogenous pain mediators such as prostaglandins after being stimulated by unphysiological osmolarity or pH of drug solution. Rocuronium has a PH of 4.0, and dilution could reduce injection pain [25], which may explain the injection pain of it [26]. Blunk and Seifert [27] demonstrated the dolorific effect of rocuronium may be on account for direct activation of C-nociceptors nerve endings with release of calcitonin prostaglandin (PG) E2 and gene-related peptide (CGRP).…”