Effective method of continuous rocuronium administration based on effect-site concentrations using a pharmacokinetic/pharmacodynamic model during propofol–remifentanil anesthesia

Moriyama, Tsuyoshi; Matsunaga, Akira; Nagata, Osamu; Enohata, Kei; Kamikawaji, Tomomi; Uchino, Erika; Kanmura, Yuichi

doi:10.1007/s00540-015-1991-2

Cited by 4 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The median rocuronium dose used is in line with previous reports. 30,31 In our study, advanced age, 12 lower BMI, and higher ASA class decreased the amount of rocuronium needed. Previous reports on the effect of BMI on rocuronium requirements are conflicting.…”

Section: Discussionsupporting

confidence: 46%

First genome-wide association study on rocuronium dose requirements shows association with SLCO1A2

Ahlström

Bergman

Jokela

et al. 2021

British Journal of Anaesthesia

View full text Add to dashboard Cite

Background: Rocuronium, a common neuromuscular blocking agent, is mainly excreted unchanged in urine (10e25%) and bile (>70%). Age, sex, liver blood flow, smoking, medical conditions, and ethnic background can affect its pharmacological actions. However, reasons for the wide variation in rocuronium requirements are mostly unknown. We hypothesised that pharmacogenetic factors might explain part of the variation. Methods: One thousand women undergoing surgery for breast cancer were studied. Anaesthesia was maintained with propofol (50e100 mg kg À1 min À1 ) and remifentanil (0.05e0.25 mg kg À1 min À1 ). Neuromuscular block was maintained with rocuronium to keep the train-of-four ratio at 0e10%. DNA was extracted from peripheral blood and genotyped with a next-generation genotyping array. The genome-wide association study (GWAS) was conducted using an additive linear regression model with PLINK software. The FINEMAP tool and data from the Genotype-Tissue Expression project v8 were utilised to study the locus further. Results: The final patient population comprised 918 individuals. Of the clinical variables tested, age, BMI, ASA physical status, and total dose of propofol correlated significantly (all P<0.001) with the rocuronium dose in a linear regression model. The GWAS highlighted one genome-wide significant locus in chromosome 12. The single-nucleotide polymorphisms (SNPs) with the most significant evidence of association were located in or near SLCO1A2. The two top SNPs, rs7967354 (P¼5.3e À11 ) and rs11045995 (P¼1.4e À10 ), and the clinical variables accounted for 41% of the variability in rocuronium dosage. Conclusions: Genetic variation in the gene SLCO1A2, encoding OATP1A2, an uptake transporter, accounted for 4% of the variability in rocuronium consumption. The underlying mechanism remains unknown.

show abstract

Section: Discussionsupporting

confidence: 46%

First genome-wide association study on rocuronium dose requirements shows association with SLCO1A2

Ahlström

Bergman

Jokela

et al. 2021

British Journal of Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Therefore, it is essential to be able to determine the optimal rates of continuous administration of Rb in accordance with the individual patient. We previously reported an effective continuous rocuronium administration method that was based on the simulated effect-site concentrations obtained from a pharmacokinetic/pharmacodynamics model during propofol anesthesia [8]. Our results showed that the simulated rocuronium concentration at the time of recovery to a first twitch (%T1) > 0% after the initial bolus administration of rocuronium was a good indicator of the optimal effect-site concentrations that would occur during continuous rocuronium administration under propofol anesthesia.…”

Section: Introductionmentioning

confidence: 90%

Continuous Rocuronium Administration Method Based on Pharmacokinetic/Pharmacodynamics Model during Propofol, Sevoflurane, and Desflurane Anesthesia

Moriyama¹,

Irie²,

Mukaihara³

et al. 2016

OJAnes

Self Cite

View full text Add to dashboard Cite

Purpose: Although rocuronium bromide (Rb) is suitable for continuous administration use, determination of optimal continuous doses is difficult due to individual differences. This study examines the efficacy of a continuous Rb administration method based on effect-site concentrations calculated by a pharmacokinetic/pharmacodynamics model during propofol, sevoflurane, and desflurane anesthesia. Methods: The 36 enrolled patients were equally divided into three groups (P; propofol, S; sevoflurane, and D; desflurane groups). After induction and administration of Rb 0.6 mg/kg, we calculated the simulated effect-site concentration at the point which the first twitch (%T1) recovered to > 0% and defined this as the Rb recovery concentration (Rbr.c.) level appropriate for continuous rocuronium administration. The continuous administration doses of Rb were adjusted to maintain Rbr.c. during surgery. The Rbr.c. and the recovery time at %T1 > 25% were recorded for each type of anesthesia. Results: Rbr.c. (µg/mL) for the P, S, and D groups were 1.54 ± 0.2, 1.24 ± 0.2, and 1.09 ± 0.2, respectively. Continuous administration doses (µg/kg/min) in the P, S, and D group were 6.7 ± 0.9, 5.2 ± 1.0, and 4.5 ± 0.8, respectively. Rbr.c. and continuous doses in the S and D groups were lower than the P group. Neuromuscular relaxations during surgery in the S and D groups were more strongly maintained than for the P group. There was also a significantly prolonged recovery duration for the %T1 > 25% in the D versus the other two groups (P < 0.05). Conclusion: Results showed that our continuous administration method was effective for maintaining sufficient muscle relaxation without excessively prolonged recovery effects for both sevoflurane and desflurane as well as propofol anesthesia.

show abstract

“…Moriyama et al [6] developed a continuous administration method for rocuronium based on data obtained after bolus administration. They calculated the effect-site concentration of rocuronium when a T1 in response to TOF stimuli appears following bolus administration (recovery concentration) under anesthesia with propofol and remifentanil using the pharmacokinetic parameters provided by Wierda et al [5].…”

mentioning

confidence: 99%

Rocuronium bromide: clinical application of single-dose pharmacokinetic models to continuous infusion

Oda¹

2017

J Anesth

View full text Add to dashboard Cite

Effective method of continuous rocuronium administration based on effect-site concentrations using a pharmacokinetic/pharmacodynamic model during propofol–remifentanil anesthesia

Abstract: The results suggest that our method may be one of the most reliable protocols for the continuous administration of Rb described to date for maintaining suitable muscle relaxation during surgery without excessively prolonged effects.

Cited by 4 publications

References 22 publications

First genome-wide association study on rocuronium dose requirements shows association with SLCO1A2

First genome-wide association study on rocuronium dose requirements shows association with SLCO1A2

Continuous Rocuronium Administration Method Based on Pharmacokinetic/Pharmacodynamics Model during Propofol, Sevoflurane, and Desflurane Anesthesia

Rocuronium bromide: clinical application of single-dose pharmacokinetic models to continuous infusion

Contact Info

Product

Resources

About