Prolonged Neuromuscular Block After Rocuronium In Postpartum Patients

Abstract

Neuromuscular block is prolonged in the postpartum period after standard doses of rocuronium. Drug administration according to lean body mass will produce a more consistent duration of block.

Rocuronium and sugammadex for rapid sequence induction of obstetric general anaesthesia

“…It is known that aminosteroid muscle relaxants can have a longer duration of action in immediately postpartum patients, 21 probably due to relative hepatic hypoperfusion in pregnancy as well as increased protein binding and competition with steroidal hormones for hepatic binding sites 16,22 . Concern over this prolonged duration of action means that there is a tendency to use the lower dose of rocuronium 0.6 mg/kg for RSI in pregnancy, despite a rate of poor or inadequate intubating conditions unless higher doses of an induction agent are used 11 .…”

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

“…Physiological and pathological changes occur during pregnancy, leading to pharmacological changes [ 106 ]. However, there were no differences in the onset times of non-depolarizing neuromuscular blocking agents in a comparison of women who were not pregnant and women immediately after giving birth [ 107 ].…”

Reversal of prolonged rocuronium neuromuscular blockade with sugammadex in an obstetric patient with transverse myelitis

“…Prolonged neuromuscular block has also been described with sevoflurane for maintenance of anaesthesia. 16 We used the facial nerve to monitor neuromuscular blockade and at the end of surgery our patient received 0.07 mg/kg neostigmine rather than the recommended dose of 0.05 mg/kg. Although it has been shown that cirrhotic patients have a 28% reduction in clearance and 55% increase in the elimination half life of rocuronium, 14 our patient's transaminases were only slightly raised and we felt that this was not a major factor in her prolonged neuromuscular blockade.…”