Pharmacodynamic behaviour of rocuronium in the elderly

Bevan, David R.; Fiset, Pierre; Balendran, P.; Lawmin, Jean-Claude; Ratcliffe, A; Donati, François

doi:10.1007/bf03011309

Cited by 64 publications

(29 citation statements)

References 33 publications

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“…The elderly group was studied because the pharmacodynamics of rocuronium are altered 14 and mivacurium has been reported to have a slightly increased duration in this age group. 31 This increased duration of mivacurium is small and was not found in the present study probably because of the small number of patients.…”

Section: Discussionmentioning

confidence: 99%

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Intubating conditions and blockade after mivacurium, rocuronium and their combination in young and elderly adults

Motamed

Donati

2000

Can J Anesth/J Can Anesth

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Purpose: Mivacurium-rocuronium combinations have been demonstrated to be more potent than either drug given alone. Combinations were compared with mivacurium and rocuronium, with respect to onset, intubating conditions, and duration of action in young and elderly adults.Methods: Fentanyl-propofol-N 2 O-isoflurane anesthesia was given to ASA I and II adults aged 18-65 yr (45 patients) and over 66 yr (45 patients). In this blinded randomized study, we compared accelerographic adductor pollicis response and visual assessment of response to facial nerve stimulation after 0.25 mg·kg -1 mivacurium, 0.6 mg·kg -1 rocuronium, and a combination of 0.08 mg·kg -1 mivacurium plus 0.2 mg·kg -1 rocuronium. Intubating conditions at 2.5 min were rated as excellent, good, fair or poor.Results: Onset times were similar for all drugs regimens and for both age groups (204-276 sec at the thumb; 142-196 sec at the eye) (P < 0.05 between muscles). Intubating conditions were similar in all groups, and rated good or excellent, except in two subjects. In young patients duration to 25% recovery was longer (P < 0.05) for rocuronium (mean ± SD) (39 ± 11 min) than for either mivacurium (23 ± 6 min), or the combination (27 ± 7 min). Duration was prolonged in the elderly for rocuronium (54 ± 17 min), and the combination ( 35 ± 11 min), but not for mivacurium (24 ± 6 min).Conclusions: Mivacurium-rocuronium combinations yield onset times and intubating conditions similar to either parent agent with only two thirds as much total drug. Duration for such a mixture is similar to that of mivacurium in young adults and slightly prolonged in the elderly.Objectif : Le mélange de rocuronium et de mivacurium est plus puissant que l'un ou l'autre de ses composants donné seul. On a comparé ce mélange au mivacurium et au rocuronium quant au délai d'installation, aux conditions d'intubation et à la durée d'action chez des adultes jeunes et âgés.Méthode : Une anesthésie au fentanyl, propofol, N 2 O et isoflurane a été administrée à 45 patients de 18 à 65 ans et à 45 sujets de plus de 65 ans. De façon randomisée et aveugle, on a comparé la réponse accélérographique de l'adducteur du pouce et l'évaluation visuelle de la réponse à la stimulation du nerf facial après 0,25 mg·kg -1 de mivacurium, 0,6 mg·kg -1 de rocuronium ou un mélange de 0,08 mg·kg -1 de mivacurium et 0,2 mg·kg -1 de rocuronium. Les conditions d'intubation à 2,5 min ont été classifiées comme excellentes, bonnes, passables ou inadéquates.Résultats : Les délais d'installation étaient semblables pour tous les myorelaxants et pour les deux groupes d'âge (204-276 sec au pouce, 142-196 sec près de l'oeil (P < 0,05 entre les muscles). Les conditions d'intubation étaient semblables dans tous les groupes et cotées bonnes ou excellentes, excepté chez deux sujets. Chez les jeunes, la durée d'action jusqu'à 25 % de récupération était plus longue (P < 0,05) pour le rocuronium (moyenne ± ET) (39 ± 11 min) que pour le mivacurium (23 ± 6 min), ou le mélange (27 ± 7 min). Chez les sujets âgés, la durée était prolo...

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Section: Discussionmentioning

confidence: 99%

“…In this respect, visual inspection of the loss of response of muscles surrounding the eye is a better guide. 12 In addition, onset and duration data might be different in the elderly 13,14 who constitute a growing part of anesthetic practice.…”

mentioning

confidence: 99%

Intubating conditions and blockade after mivacurium, rocuronium and their combination in young and elderly adults

Motamed

Donati

2000

Can J Anesth/J Can Anesth

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“…Further research is needed to establish the PTC/T 1 relationship when other NMBDs are used in elderly population and document any deviation from the expected early recovery profile in younger adults. In contrast to the significant affects that aging may have on the pharmacokinetics of NMBDs, no evidence exists that old age may be associated with any changes in the pharmacodynamic response [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Post-Tetanic Count Recovery after Cisatracurium in Elderly Patients

El-Orbany¹,

Joseph²,

Salem³

2011

J Anesthe Clinic Res

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Background: The temporal relationship between recovery of a certain post-tetanic count (PTC) and the recovery of the first twitch (T 1 ) in the train-of-four (the PTC-T 1 interval), is specific for each neuromuscular blocking drug (NMBD). A previous study reported prolongation of the PTC -T 1 interval in the elderly after rocuronium. The ability to accurately predict the return of T 1 is an important component of PTC monitoring since it may affect clinical decisions about administration versus withholding a maintenance dose of the NMBD. This study was designed to evaluate PTC recovery from intense cisatracurium-induced NMB in geriatrics and investigate its relationship with T 1 . Methods:After IRB approval, Thirty-two patients who are older than 65yr were recruited and the informed consent signed. After anesthesia induction, neuromuscular monitoring was performed using acceleromyography. Cisatracurium 0.15 mg/kg was administered and tracheal intubation performed when the response to TOF stimulation was abolished. Cycles of post-tetanic stimulation were applied every 6 minutes with TOF monitoring in between. Anesthesia was maintained with propofol infusion and nitrous oxide in oxygen 60:40. Measurements included time to reappearance, and number of PTC, time to T 1 , and the number of PTC when T 1 was imminent. The correlation between PTC and T 1 was also studied.Results: 32 subjects were studied 32. The mean time needed for the first response to post-tetanic stimulation (PTC 1 ) to appear was 34.4 ± 5.5 minutes and the mean time needed for T 1 to reappear was 45.7 ± 5.8 minutes. The median number of detectable PTC just before or coinciding with T 1 appearance was 9. There was a strong correlation between the number of detectable PTC and time to T 1 appearance (Correlation coefficient 0.929). Conclusions:There is a consistent temporal relationship between the number of PTC and the time to T 1 recovery after cisatracurium in elderly patients. This may allow more accurate control and predictable recovery from intense cisatracurium-induced block in the elderly.

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“…[11][12][13] According to the above guidelines, individuals aged 18-65 yr are categorized as adults; 6 however, it is unreasonable to include those individuals as a single group in the investigation of a drug's duration of effect. As a result, to exclude the influence of age on the duration of action of neuromuscular blocking agents, we also limited the subjects to 45-60-yr-old senior adult female patients.…”

Section: Discussionmentioning

confidence: 99%

In non-obese patients, duration of action of rocuronium is directly correlated with body mass index

Fujimoto

Tanahira

Nishi

et al. 2013

Can J Anesth/J Can Anesth

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Background Administration of neuromuscular blocking agents using a dose calculated on actual body weight carries a risk of prolonged duration of action in obese patients whose body mass index (BMI) is [ 30 kgÁm -2 . In the present study, we hypothesized that there could be a correlation between BMI and the duration of action of rocuronium administered according to actual body weight in non-obese patients, in particular, overweight (BMI 25-30 kgÁm -2 ) and underweight patients (BMI \ 18.5 kgÁm -2 ). Methods Sixteen female patients (BMI 15-30 kgÁm -2 , aged 45-60 yr) scheduled for elective surgery under total intravenous anesthesia were included in this study. Rocuronium 0.9 mgÁkg -1 was administered, and adductor pollicis train-of-four responses following ulnar nerve stimulation were monitored every minute with acceleromyography. The times from the injection of rocuronium until spontaneous recovery of first twitch to 5% (5% Duration) and 25% (25% Duration) of baseline were measured, and the correlation with BMI was analyzed.Results A significant correlation between 5% Duration and BMI (r 2 = 0.56; P \ 0.001) was found by linear regression analysis. A significant correlation was also found between 25% Duration and BMI (r 2 = 0.49; P = 0.003). Conclusion In adult female patients with a BMI in the range of 15-30 kgÁm -2 , the duration of action of rocuronium increases with BMI when the drug is administered on the basis of mg per actual kg body weight. RésuméContexte L'administration de curares a`une dose calcule´e en fonction du poids re´el comporte le risque d'une dure´e d'action prolonge´e chez les patients obe`ses dont l'indice de masse corporelle (IMC) est [ 30 kgÁm -2 . Dans cette e´tude, nous avons e´mis l'hypothe`se qu'il pourrait exister une corre´lation entre l'IMC et la dure´e d'action du rocuronium administre´selon le poids re´el chez les patients non obe`ses, en particulier chez les patients en surcharge ponde´rale (IMC 25-30 kgÁm -2 ) et en insuffisance ponde´rale (IMC \ 18,5 kgÁm -2 ). Méthode Seize patientes (IMC 15-30 kgÁm -2

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Pharmacodynamic behaviour of rocuronium in the elderly

Cited by 64 publications

References 33 publications

Intubating conditions and blockade after mivacurium, rocuronium and their combination in young and elderly adults

Intubating conditions and blockade after mivacurium, rocuronium and their combination in young and elderly adults

Post-Tetanic Count Recovery after Cisatracurium in Elderly Patients

In non-obese patients, duration of action of rocuronium is directly correlated with body mass index

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