Neues in der perioperativen antibiotischen Prophylaxe

Kujath, P.; Bouchard, R.; Scheele, J.; Esnaashari, Hamed

doi:10.1007/s00104-006-1194-3

Cited by 28 publications

(10 citation statements)

References 46 publications

(32 reference statements)

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“…When combined, such drugs may share a common adverse effect that is clinically insignificant when each drug is given separately. Local anesthetics can be used regionally or intravenously for perioperative pain control, and to prevent surgical site infection, antibiotics are administered before anesthesia [1]. In the perioperative period, some patients may receive combinations of therapeutic doses of the above drugs as well as a neuromuscular (NM) blocker.…”

Section: Introductionmentioning

confidence: 99%

Do bupivacaine, clindamycin, and gentamicin at their clinical concentrations enhance rocuronium-induced neuromuscular block?

Lee

Park

et al. 2013

Korean J Anesthesiol

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BackgroundBupivacaine, clindamycin, and gentamicin inhibit neuromuscular (NM) conduction. When they are combined, they may synergistically reduce the effective concentration of each to the therapeutic concentration in augmenting rocuronium-induced NM block. Thus, the aim of this study was to investigate whether combinations of the three drugs, at around their therapeutic concentrations, potentiate rocuronium-induced NM block.MethodsFifty-seven left-phrenic nerve hemidiaphragms (Male S-D rats, 150-250 g) were hung in a 20-ml organ bath filled with Krebs solution. Three consecutive single-twitch tensions (0.1 Hz) and one tetanic tension (50 Hz for 1.9 s) were obtained. A Krebs solution was premixed with concentration sets of bupivacaine and clindamycin, bupivacaine and gentamicin, or bupivacaine, clindamycin and gentamicin. Then, the concentration of rocuronium was cumulatively increased in the Krebs solution (1, 3, 5, 7, 9, 12, 14, 16, 18, and 20 µM) until an 80% to 90% reduction in single twitch was attained. The effective concentrations for each experiment were determined with the probit model.ResultsThe combinations of bupivacaine, clindamycin, and gentamicin enhanced rocuronium-induced NM block. When the three drugs were applied simultaneously, their concentrations were reduced to near-therapeutic levels in potentiating the action of rocuronium.ConclusionsBupivacaine, clindamycin, and gentamicin blocked NM conduction, and when all three drugs were applied together, they augmented rocuronium-induced NM block at their near-therapeutic concentrations. Clinicians should be aware of the cooperability in NM block between drugs that interrupt NM conduction.

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Section: Introductionmentioning

confidence: 99%

Do bupivacaine, clindamycin, and gentamicin at their clinical concentrations enhance rocuronium-induced neuromuscular block?

Lee

Park

et al. 2013

Korean J Anesthesiol

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“…Because many antibiotics are administered 60 minutes before surgical incision to prevent surgical site infection [1], perioperative antimicrobials are typically administered before anaesthesia. Anaesthesiologists are often responsible for the administration of antibiotics in the preoperative and intraoperative periods; however, they may be unfamiliar that the administration of antibiotics is associated with the potentiation of neuromuscular blocking (NMB) agents [2].…”

Section: Introductionmentioning

confidence: 99%

“…Clindamycin has typically been used to treat infections that are caused by anaerobic and aerobic bacteria other than enterococci [1]. In addition to having antibacterial effects, clindamycin produces an open ion channel block on the end-plate [7,8] and decreases acetylcholine release at the motor nerve terminal [9], thus, prolonging or enhancing neuromuscular block that is caused by nondepolarizing NMB drugs [10-14].…”

Section: Introductionmentioning

confidence: 99%

The antagonistic effect of neostigmine on rocuronium-, clindamycin-, or both-induced neuromuscular blocking in the rat phrenic nerve-hemidiaphragm

Kim

Lee

Chung

et al. 2011

Korean J Anesthesiol

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BackgroundNeostigmine augments clindamycin-induced neuromuscular block and antagonizes rocuronium-induced neuromuscular block; however, it remains unclear whether neostigmine enhances the neuromuscular blocking (NMB) that is caused by combinations of rocuronium and clindamycin. The intent of this study was to determine whether neostigmine potentiates the muscle relaxation that is induced by combinations of rocuronium and clindamycin and to estimate whether both clindamycin and rocuronium have synergistic actions on NMB.MethodsForty-one left phrenic nerve-hemidiaphragms (from male Sprague-Dawley rats, 150-250 g) were mounted in Krebs solution. Three consecutive single twitches (ST, 0.1 Hz) and one tetanic tension (50 Hz for 1.9 s) were obtained for each increase in concentration of rocuronium or clindamycin. The concentrations of rocuronium were cumulatively increased until an 80% to 90% reduction in ST was attained in the Krebs solutions pre-treated with 0 (n = 5), 0.1 (n = 1), 0.25 (n = 1), 0.5 (n = 4), or 1.0 (n = 1) mM clindamycin or with 0 (n = 4), 0.1 (n = 1), 0.5 (n = 5), 1.0 (n = 5), or 2.0 (n = 4) mM clindamycin in combination with 250 nM neostigmine, and so were the concentrations of clindamycin in the Krebs solutions pre-treated with 0 (n = 6) or 250 nM (n = 6) neostigmine.ResultsClindamycin increased the potency of rocuronium for ST and tetanic fade, irrespective of the presence of neostigmine. Neostigmine shifted the concentration-response curve of rocuronium to the right in the presence or absence of clindamycin. The interaction between rocuronium and clindamycin was synergistic when clindamycin concentrations were in excess of 0.5 mM, irrespective of the presence of neostigmine.ConclusionsNeostigmine may partially antagonize the neuromuscular block that is induced by a combination of clindamycin and rocuronium. Clinicians are advised to be aware that clindamycin synergistically increases the degree of rocuronium-induced neuromuscular block, even when neostigmine is present.

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“…Importantly, two large prospective studies observed the lowest risk of SSI when SAP was given within 30 minutes prior to incision, and the National Surgical Infection Prevention Project simply recommends administering SAP as close to the incision time as possible [51-53]. Similar statements are made in European guidelines [54,55]. …”

Section: Introductionmentioning

confidence: 94%

Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial

Mujagić

Zwimpfer

Marti

et al. 2014

Trials

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BackgroundSurgical site infections are the most common hospital-acquired infections among surgical patients. The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections . The optimal timing of this procedure is still a matter of debate. While most studies suggest that it should be given as close to the incision time as possible, others conclude that this may be too late for optimal prevention of surgical site infections. A large observational study suggests that surgical antimicrobial prophylaxis should be administered 74 to 30 minutes before surgery. The aim of this article is to report the design and protocol of a randomized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis.Methods/DesignIn this bi-center randomized controlled trial conducted at two tertiary referral centers in Switzerland, we plan to include 5,000 patients undergoing general, oncologic, vascular and orthopedic trauma procedures. Patients are randomized in a 1:1 ratio into two groups: one receiving surgical antimicrobial prophylaxis in the anesthesia room (75 to 30 minutes before incision) and the other receiving surgical antimicrobial prophylaxis in the operating room (less than 30 minutes before incision). We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than 30 minutes before the scheduled incision. The primary outcome is the occurrence of surgical site infections during a 30-day follow-up period (one year with an implant in place). When assuming a 5% surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room, the planned sample size has an 80% power to detect a relative risk reduction for surgical site infections of 33% when administering surgical antimicrobial prophylaxis in the anesthesia room (with a two-sided type I error of 5%). We expect the study to be completed within three years.DiscussionThe results of this randomized controlled trial will have an important impact on current international guidelines for infection control strategies in the hospital. Moreover, the results of this randomized controlled trial are of significant interest for patient safety and healthcare economics.Trial registrationThis trial is registered on ClinicalTrials.gov under the identifier NCT01790529.

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Neues in der perioperativen antibiotischen Prophylaxe

Cited by 28 publications

References 46 publications

Do bupivacaine, clindamycin, and gentamicin at their clinical concentrations enhance rocuronium-induced neuromuscular block?

Do bupivacaine, clindamycin, and gentamicin at their clinical concentrations enhance rocuronium-induced neuromuscular block?

The antagonistic effect of neostigmine on rocuronium-, clindamycin-, or both-induced neuromuscular blocking in the rat phrenic nerve-hemidiaphragm

Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial

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