Muscle relaxants suitable for day case surgery

Geldner, Götz; Wulf, Hinnerk

doi:10.1097/00003643-200111001-00009

Cited by 2 publications

(4 citation statements)

References 25 publications

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“…1 However, succinylcholine has serious side effects and is contraindicated in many clinical situations. 2 The low potency of the non-depolarizing agent, rocuronium, is associated with a rapid onset of action. For this reason, rocuronium has been recommended as a component of a rapid sequence induction of anesthesia at doses varying from 0.6 to 1.2 mg Á kg -1 (2-4 times the effective dose for 95% twitch depression or 2 to 4 9 ED 95 ) to obtain intubating conditions equivalent to those achieved with succinylcholine.…”

Section: Résumémentioning

confidence: 99%

Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Siddik-Sayyid

Taha

Kanazi

et al. 2009

Can J Anesth/J Can Anesth

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Purpose The shortest time to tracheal intubation, the best intubating conditions, and the shortest duration of muscle paralysis are achieved with succinylcholine. During a lidocaine-remifentanil-propofol induction of anesthesia, we compared intubating conditions 90 s after administering low-dose rocuronium (0.3 mg Á kg -1 ) with intubating conditions 60 s after administering succinylcholine 1.5 mg Á kg -1 . Methods The randomized double-blind study included 184 healthy adult patients scheduled for elective surgery. Anesthesia was induced in all patients with lidocaine 1.5 mg Á kg -1 , remifentanil 2 lg Á kg -1 , and propofol 2 mg Á kg -1 administered over 30 s. In one group, rocuronium 0.3 mg Á kg -1 was administered before the induction sequence, and in the other group, succinylcholine 1.5 mg Á kg -1 was administered after the induction sequence. Laryngoscopy was attempted 90 s after rocuronium administration and 60 s after succinylcholine administration. Intubating conditions were assessed as excellent, good, or poor on the basis of ease of laryngoscopy, position of the vocal cords, and reaction to insertion of the tracheal tube and cuff inflation. Results There were 92 patients per group. In the rocuronium group, intubating conditions were excellent in 83 patients (90%), good in 8 (9%), and poor in 1 (1%), not significantly different from the intubating conditions in the succinylcholine group, which were excellent in 88 patients (96%), good in 3 (3%), and poor in 1 (1%) (P = 0.3). Conclusion During a lidocaine-remifentanil-propofol induction of anesthesia, rocuronium 0.3 mg Á kg -1 administered before the induction sequence provides intubating conditions comparable to those achieved with succinylcholine 1.5 mg Á kg -1 administered after the induction sequence. RésuméObjectif La succinylcholine permet de re´aliser l'intubation trache´ale dans les plus courts de´lais, avec les meilleures conditions d'intubation et la dure´e la plus courte de paralysie musculaire. Au cours d'une induction de l'anesthe´sie avec lidocaı¨ne-re´mifentanil-propofol, nous avons compare´les conditions d'intubation 90 sec apre`s avoir administre´du rocuronium a`faible dose (0,3 mgÁkg -1 ) aux conditions d'intubation 60 sec apre`s avoir administre´de la succinylcholine a`1,5 mgÁkg -1 . Méthode Au total, 184 patients adultes sains devant subir une chirurgie non urgente ont pris part a`cette e´tude randomise´e en double aveugle. L'anesthe´sie a e´te´induite chez tous les patients avec de la lidocaı¨ne (1,5 mgÁkg -1 ), du re´mifentanil (2 lgÁkg -1 ) et du propofol (2 mgÁkg -1 ) administre´s sur une pe´riode de 30 sec. Dans un groupe, du rocuronium (0,3 mgÁkg -1 ) a éte´administre´avant la

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Section: Résumémentioning

confidence: 99%

Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Siddik-Sayyid

Taha

Kanazi

et al. 2009

Can J Anesth/J Can Anesth

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“…In den letzten Jahren entwickelte sich im Rahmen sich ständig wandelnder gesundheitspolitischer Rahmenbedingungen, Interessen der Kostenträger und Bedürfnissen der Patienten ein Trend mit stetig steigender Anzahl ambulanter medizinischer Leistungen wie auch ambulanter operativer Eingriffe [12]. So lag die Anzahl ambulanter bzw.…”

Section: Diskussionunclassified

“…So lag die Anzahl ambulanter bzw. Zum Vergleich erfolgten in den USA bereits im Jahre 1994 knapp 70% aller chirurgischer Eingriffe insbesondere bei Kindern in tageschirurgischen Einrichtungen [5,12,16]. Zum Vergleich erfolgten in den USA bereits im Jahre 1994 knapp 70% aller chirurgischer Eingriffe insbesondere bei Kindern in tageschirurgischen Einrichtungen [5,12,16].…”

Section: Diskussionunclassified

“…Plasma cholinesterase · Prolonged apnea · Mivacurium · Succinylcholine kontrollierte/assistierte Nachbeatmung bis zum vollständigen Abklingen der prolongierten neuromuskulären Blockade mit Wiedereintritt einer suffizienten Spontanatmung als Therapie der Wahl [18,26].Aufgrund einer stetig ansteigenden Zahl ambulanter operativer Eingriffe und ambulanter Anästhesien [5] gewinnt diese Problematik mit Kenntnis der zugrunde liegenden pathophysiologischen Zusammenhänge und der möglichen Therapieoptionen sowie die Auswahl des geeignetesten Muskelrelaxans im Rahmen ambulanter operativer Eingriffe zunehmend an Bedeutung [12].…”

Section: Introductionunclassified

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Plasmacholinesterasevarianten als Ursache prolongierter neuromuskul�rer Blockaden

Lang¹,

Lukasewitz²,

Wulf³

et al. 2002

Der Anaesthesist

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Succinylcholine and mivacurium are degraded more slowly in patients with a qualitatively or quantitatively reduced plasma cholinesterase and are therefore known for inducing a prolonged postoperative apnea. Perioperative laboratory screening even including plasma cholinesterase activity testing will not prevent this due to a possible aberration only in the qualitative cholinesterase activity. This is illustrated by introducing two cases reports of prolonged apnea after administration of mivacurium or succinylcholine. The pathophysiology of plasma cholinesterase is reviewed including genetically determined variants and the degradation pathways of mivacurium and succinylcholine. Only extensive laboratory chemical tests are sufficient to prevent this possible complication. Due to the rare incidence there is no evidence for recommending these laboratory investigations in all patients. Once prolonged apnea occurs following the administration of mivacurium or succinylcholine the best choice is ongoing ventilation combined with a sufficient sedation.

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Muscle relaxants suitable for day case surgery

Cited by 2 publications

References 25 publications

Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Plasmacholinesterasevarianten als Ursache prolongierter neuromuskul�rer Blockaden

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