Neuromuscular Block and Blocking Agents in 2018

Unterbuchner, Christoph

doi:10.5152/tjar.2018.200318

Cited by 6 publications

(5 citation statements)

References 81 publications

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“…We are proud to have a high acceptance rate among our anesthesia personnel for objective NMB monitoring, provided that all our institutional anesthesia equipment has integrated TOFR and that our institution participates in the High Proficiency Residence Program in anesthesia. Nevertheless, we are well aware that such an acceptance rate is not common practice worldwide yet [ 16 ]. Other problems, such as the availability of reversal agents, also play a role in mid to low-income countries such as ours as a cause of suboptimal treatment, an issue we will handle deep below.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, to the possible incomplete understanding of the NMB effects and pharmacokinetics, a significant rate of underused monitoring is reported worldwide either by lack of devices, protocols, or culture to use monitoring [ 13 , 16 ]. As considered above, this problem is complicated even more when there is difficulty acquiring trustable and sensible cut-off values [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study

et al. 2023

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Introduction NMB facilitates intubating conditions in general anesthesia. However, it is associated with significant residual postoperative paralysis and morbidity. Objective To investigate the rate of underdiagnosed residual NMB based on two TOFR criteria (< 0.91 and < 1.00). Methods We performed a retrospective study adhering to STROBE guidelines. We included patients undergoing ENT surgery using single-dose neuromuscular block for balanced general anesthesia from June to December 2018. We collected demographic and anthropometric data, ASA score, NMBA dose, TOFR recordings at 5, 30 and 60 min and end of the surgery, anesthesia and surgery time, and administration of reversal agent. Statistical analysis included descriptive and dispersion measures statistics, curve and cross tables for residual NMB on different TOFR criteria with sub-analysis for AR, RR, and OR in patients over 65 years old. Results We included 57 patients, mean age 41; 43 females and 14 males. Mean anesthetic and surgical time were 139.4 and 116.1 min, respectively. All the patients received rocuronium under a mean ponderal single-dose of 0.48 mg/kg. Residual NMB rates were 29.9 and 49.1% for a TOFR < 0.91 and < 1.00, respectively. Older adults had an OR of 6.08 for residual NMB. Conclusions The rate of residual NMB was 29.9 to 49.1%, depending on the criteria used (TOFR < 0.91 and < 1.00, respectively). Patients above 65 years old had an increased risk of residual NMB (6.08 OR) and clinical symptoms related to residual NMB (11.75 OR). We recommend future research aiming to provide a specific surveillance protocol for patients above 65 years old, including shorter-action NMB, early reversal, and prolonged surveillance using the TOFR criteria of < 1.00 to identify patients at risk of residual NMB readily.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study

et al. 2023

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“…According to a multicenter study [ 17 ], sugammadex sodium reduces the risk of pulmonary complications by 30%, risk of pneumonia by 47%, and risk of respiratory failure by 55%, compared with neostigmine. However, the evidence from various studies on the effect of different neuromuscular blockade antagonists on PPCs is controversial, with some studies suggesting that there is no reduction with the use of different neuromuscular blockade antagonists [ 10 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Effects of Sugammadex and Neostigmine on Postoperative Neuromuscular Blockade Recovery in Patients with Interstitial Lung Diseases Undergoing Transbronchial Cryobiopsy: A Randomized Trial

Lu,

Chen,

et al. 2024

Med Sci Monit

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Background While many studies have been conducted on sugammadex sodium and neostigmine in patients undergoing general anesthesia, few have explored their effects in patients with interstitial lung diseases (ILDs). Material/Methods Sixty-three patients who underwent transbronchial cryobiopsy under general anesthesia were enrolled in a prospective randomized study. The patients were randomly divided into 2 groups: neostigmine combined with atropine group (group C, n=32) and sugammadex group (group S, n=31). Induction and maintenance of anesthesia were the same in both groups. Patients received rocuronium during anesthesia. At the end of the procedure, when the T2 of the train-of-four stimulation technique (TOF) monitoring appeared, neostigmine 0.04 mg/kg combined with atropine 0.02 mg/kg was injected intravenously in group C, and sodium sugammadex 2 mg/kg was injected intravenously in group S. Time from administration of muscle relaxant antagonist to recovery of TOF ratio (TOFr) to 0.9 and extubation time were recorded. The residual rate of neuromuscular blockade at 1, 3, 5, 7, and 10 min after extubation was calculated. Results Compared to group C, group S had a significantly shorter recovery time of TOFr to 0.9 (4.0[2.0] min vs 14.0[11.0] min, P <0.001) and extubation time (4.0[3.0] min vs 11.0[7.0] min, P <0.001). The residual rate of neuromuscular blockade was remarkably lower in group S than in group C at 3, 5, and 7 min after extubation (3.2% vs 31%, 0% vs 25%, 0% vs 6%, P <0.05). Conclusions Sugammadex is more effective than neostigmine in reversing the muscle-relaxant effect of rocuronium bromide in patients with ILDs.

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“…After analyzing the NMM, we should see what happened with the neuromuscular reversal and its influence on POPC. The controversy 31 , 32 lies with some studies, such as Grosse-Sundrup et al 2 , POPULAR 14 , or Li et al 33 , which have reported that reversal, with one reversal agent and another, was not able to decrease these postoperative complications. Moreover, they questioned the utility of quantitative monitoring “the use of reversal agents or neuromuscular monitoring could not decrease this risk.” 14 .…”

Section: Discussionmentioning

confidence: 99%

Predictive study of pharmacological reversal for residual neuromuscular blockade and postoperative pulmonary complications: a prospective, observational, cohort study

Aragón-Benedí

Pascual-Bellosta²,

Ortega-Lucea³

et al. 2022

Sci Rep

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In recent years, some studies have generated controversy since they conclude that intraoperatively pharmacological reversal of neuromuscular blockade does not contribute to the reduction of postoperative residual neuromuscular blockade or pulmonary complications. Therefore, the main objective of this study was to assess the incidence of residual neuromuscular blockade and postoperative pulmonary complications according to spontaneous or pharmacological neuromuscular reversal. The secondary aim was to present a prognostic model to predict the probability of having postoperative residual neuromuscular blockade depending on a patient's comorbidities and intraoperative neuromuscular blocking agents management. A single-center, prospective, observational cohort study including patients undergoing surgical procedures with general anesthesia was designed. A total of 714 patients were analyzed. Patients were divided into four groups: cisatracurium with spontaneous reversal, cisatracurium with neostigmine antagonism, rocuronium with spontaneous reversal, and rocuronium with sugammadex antagonism. According to our binomial generalized linear model, none of the studied comorbidities was a predisposing factor for an increase in the residual neuromuscular blockade. However, in our study, pharmacological reversal of rocuronium with sugammadex and, particularly, neuromuscular monitoring during surgery were the factors that most effectively reduced the risk of residual neuromuscular blockade as well as early and late postoperative pulmonary complications.

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Neuromuscular Block and Blocking Agents in 2018

Cited by 6 publications

References 81 publications

Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study

Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study

Comparison of Effects of Sugammadex and Neostigmine on Postoperative Neuromuscular Blockade Recovery in Patients with Interstitial Lung Diseases Undergoing Transbronchial Cryobiopsy: A Randomized Trial

Predictive study of pharmacological reversal for residual neuromuscular blockade and postoperative pulmonary complications: a prospective, observational, cohort study

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