Optimal neuromuscular blocking effects of remifentanil during tracheal intubation under general anesthesia

Kwon, So Young; Chung, Si Wook; Joo, Jin

doi:10.1177/0300060518772227

Cited by 2 publications

(3 citation statements)

References 20 publications

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“…29 The emergence of other possible adjuncts with established adverse risk profiles, such as remifentanil, appear to have made little impact on reducing doses of NMBAs. 58 A strength of this prospectively registered systematic review is that it adhered to international recommendations for this type of article. We used the GRADE criteria to assess the overall quality of evidence (Supplementary material S10).…”

Section: Discussionmentioning

confidence: 99%

Reducing the dose of neuromuscular blocking agents with adjuncts: a systematic review and meta-analysis

Weber

Abbott

Ackland

2021

British Journal of Anaesthesia

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Background: Acute global shortages of neuromuscular blocking agents (NMBA) threaten to impact adversely on perioperative and critical care. The use of pharmacological adjuncts may reduce NMBA dose. However, the magnitude of any putative effects remains unclear. Methods: We conducted a systematic review and meta-analysis of RCTs. We searched Medline, Embase, Web of Science, and Cochrane Database (1970e2020) for RCTs comparing use of pharmacological adjuncts for NMBAs. We excluded RCTs not reporting perioperative NMBA dose. The primary outcome was total NMBA dose used to achieve a clinically acceptable depth of neuromuscular block. We assessed the quality of evidence using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) criteria. Data are presented as the standardised mean difference (SMD); I 2 indicates percentage of variance attributable to heterogeneity. Results: From 3082 records, the full texts of 159 trials were retrieved. Thirty-one perioperative RCTs met the inclusion criteria for meta-analysis (n¼1962). No studies were conducted in critically ill patients. Reduction in NMBA dose was associated with use of magnesium (SMD: e1.10 [e1.44 to e0.76], P<0.001; I 2 ¼85%; GRADE¼moderate), dexmedetomidine (SMD: e0.89 [e1.55 to e0.22]; P¼0.009; I 2 ¼87%; GRADE¼low), and clonidine (SMD: e0.67 [e1.13 to e0.22]; P¼0.004; I 2 ¼0%; GRADE¼low) but not lidocaine (SMD: e0.46 [e1.01 to e0.09]; P¼0.10; I 2 ¼68%; GRADE¼moderate). Meta-analyses for nicardipine, diltiazem, and dexamethasone were not possible owing to the low numbers of studies. We estimated that 30e50 mg kg À1 magnesium preoperatively (8e15 mg kg h À1 intraoperatively) reduces rocuronium dose by 25.5% (interquartile range, 14.7e31). Conclusions: Magnesium, dexmedetomidine, and clonidine may confer a clinically relevant sparing effect on the required dose of neuromuscular block ing drugs in the perioperative setting. Systematic review registration: PROSPERO: CRD42020183969.

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Section: Discussionmentioning

confidence: 99%

Reducing the dose of neuromuscular blocking agents with adjuncts: a systematic review and meta-analysis

Weber

Abbott

Ackland

2021

British Journal of Anaesthesia

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“…The significant negative correlation between the amount of fentanyl and lidocaine and the onset time of the NMB indicated that the higher the dose of fentanyl and lidocaine, the shorter the NMB onset. However, a previous study described that remifentanil, which is also an opioid mu-receptor agonist, increases the time required to reach TOF=0 in a dose-dependent way in human patients 26. In the present study, the use of fentanyl and lidocaine without a significant decrease in the fraction of expired isoflurane could have enhanced muscle relaxation indirectly and, therefore, decreased the NMB onset.…”

Section: Discussionmentioning

confidence: 46%

“…However, a previous study described that remifentanil, which is also an opioid mu-receptor agonist, increases the time required to reach TOF=0 in a dose-dependent way in human patients. 26 In the present study, the use of fentanyl and lidocaine without a significant decrease in the fraction of expired isoflurane could have enhanced muscle relaxation indirectly and, therefore, decreased the NMB onset. In addition, the fentanyl and lidocaine groups had a higher number of dogs administered boluses of crystalloid and colloid, suggesting that they had episodes of hypotension requiring intravascular volume expansion.…”

Section: Discussionmentioning

confidence: 51%

Onset and duration of cis‐atracurium neuromuscular block during fentanyl and lidocaine infusions in isoflurane‐anaesthetised dogs

Ida¹,

Van-Wijnsberghe²,

Tutunaru³

et al. 2020

Veterinary Record

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BackgroundThis retrospective study assessed the onset and duration of the neuromuscular block (NMB) induced by cis-atracurium 0.15 mg/kg intravenously with and without fentanyl or lidocaine infusions in 45 isoflurane-anaesthetised dogs.MethodsDogs with neuromuscular function assessed by a calibrated train-of-four (TOF) monitor with stimulation (every 13 s) of the peroneal nerve were included. The onset and duration of the NMB were defined as the time from cis-atracurium administration until TOF=0 and the time during TOF=0 display, respectively.ResultsThe NMB onset was shorter during fentanyl (mean±sd) (1.9±0.7 minutes; P=0.0042) and lidocaine (2.0±0.7 minutes; P=0.0154) compared with control (2.9±0.8 minutes). The NMB duration was shorter in the fentanyl (27.5±7.3 minutes; P=0.0491), but not in the lidocaine group (32.3±6.9 minutes; P=0.0790), compared with control (33.7±9.1 minutes). The NMB onset was poorly but significantly correlated with the dose of fentanyl and lidocaine administered before cis-atracurium (r=−0.3396; P=0.0225). The fentanyl and lidocaine groups received more crystalloid and colloid boluses than the control.ConclusionsFentanyl and lidocaine shortened the NMB onset and the former decreased the NMB duration. Further prospective studies are required to clarify whether this was associated with an indirect decrease in blood pressure or a direct interaction between cis-atracurium and fentanyl and lidocaine.

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Optimal neuromuscular blocking effects of remifentanil during tracheal intubation under general anesthesia

Cited by 2 publications

References 20 publications

Reducing the dose of neuromuscular blocking agents with adjuncts: a systematic review and meta-analysis

Reducing the dose of neuromuscular blocking agents with adjuncts: a systematic review and meta-analysis

Onset and duration of cis‐atracurium neuromuscular block during fentanyl and lidocaine infusions in isoflurane‐anaesthetised dogs

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