Reduced duration of muscle relaxation with rocuronium in a normocalcemic hyperparathyroid patient

Munir, Muhammad A.; Jaffar, M. Arfan; Arshad, Muhammad; Akhter, M. Shahab; Zhang, Junming

doi:10.1007/bf03018640

Cited by 12 publications

(4 citation statements)

References 11 publications

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“…In motor neurons, presynaptic voltage-gated calcium channel activation produces neuromuscular junction’s synaptic vesicle to release acetylcholine, which eventually causes muscle contraction. Some studies report that increased ionized calcium levels decrease sensitivity to non-depolarizing NMBA and enhance neuromuscular recovery (Ju et al, 2017 ; Munir et al, 2003 ). When comparing TOF ratio, equalizing the use of calcium between groups would be helpful.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the TOFscan and the TOF-Watch SX during pediatric neuromuscular function recovery: a prospective observational study

et al. 2021

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Background TOFscan is a three-dimensional acceleromyography neuromuscular monitoring device that does not require initial calibration before muscle relaxant injection. This study aimed to compare TOFscan with TOF-Watch SX, the currently widely accepted uni-dimensional acceleromyography, for use among the pediatric population. We aimed to assess the agreement between TOFscan with TOF-Watch SX in the pediatric population’s neuromuscular recovery. Methods A total of 35 children aged 6–12 years were enrolled. Prior to any muscle relaxant injection, TOFscan and TOF-Watch SX were applied at each opposite arm and monitoring began concurrently throughout neuromuscular recovery. Calibration was performed for TOF-Watch SX, and train-of-four values were recorded every 15 s. Agreement between the two devices was evaluated with Modified Bland-Altman analysis. Results The bias between TOF-Watch SX and TOFscan were all within the 95% limits of agreement. The bias and standard deviation were smaller and the limit of agreement was narrower in the normalized group than in the non-normalized group [normalized bias −0.002 (95% CI, −0.013 to 0.010), standard deviation (SD) 0.111 vs non-normalized bias 0.010 (95% CI, −0.003 to 0.0236), SD 0.127]. Conclusions TOFscan reliably demonstrated lack of bias and good concordance with TOF-Watch SX throughout the neuromuscular recovery, especially when normalized. Despite technical limitations, the two devices were unbiased along the path of spontaneous and pharmacological reversal in pediatric patients. Trial registration ClinicalTrials.gov NCT03775603. Registered on 13 March 2018

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Section: Discussionmentioning

confidence: 99%

Comparison of the TOFscan and the TOF-Watch SX during pediatric neuromuscular function recovery: a prospective observational study

et al. 2021

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“…On the other hand, in patients with hyperparathyroidism and severe hypercalcemia, there was an antagonistic effect on vecuronium wherein the onset was slower and the duration was shorter than in patients with normo-calcemia [18]. Primary hyperparathyroidism may cause Ach receptor upregulation, resulting in reduced rocuronium action time [19]. Magnesium also has a suppressing effect on transmitter release if it preceded the depolarizing pulse, in contrast to calcium, like CCB [2].…”

Section: Some Previous Studies On Drug Interactions Between Ionized Cmentioning

confidence: 99%

Comparison of Neuromuscular Blockade Recovery Co-Administered With Neostigmine and Different Doses of Calcium Gluconate: A Randomized Control Trial

Choi

Park

Kim

et al. 2020

Preprint

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Background: Calcium increases the probability of transmitter release at the neuromuscular junction. However, it is not known whether there is a dose-dependent relationship between the dosage of calcium gluconate and the probability of transmitter release for non-depolarizing neuromuscular blockade (NMB) recovery by acetylcholinesterase inhibitors (AchEIs). This study compared the neuromuscular recovery time and the incidence of postoperative residual curarization (PORC) according to the dosage of calcium gluconate co-administered with neostigmine in three patient groups.Methods: Patients were randomly allocated to a control group, a 5 mg/kg calcium gluconate group (calcium 5 group), or a 10 mg/kg calcium gluconate group (calcium 10 group). The primary endpoint was neuromuscular recovery time. The secondary endpoints were the incidence of PORC at 5, 10, and 20 minutes after reversal administration and the train-of-four ratio (TOFr) at each time point.Results: The neuromuscular recovery time was 5.3 minutes in the control group, 3.9 minutes in the calcium 5 group, and 4.1 minutes in the calcium 10 group, respectively (P=0.012). Neuromuscular recovery time was significantly different between the control and calcium 10 groups (P=0.017). The incidence of PORC at 5 minutes after neostigmine administration was 12 (46.2%) in the control group, 4 (15.4%) in the calcium 5 group, and 4 (15.4%) in the calcium 10 group, respectively, with statistical significance (P=0.014). Conclusions: The co-administration of 10 mg/kg calcium gluconate with neostigmine achieved early NMB recovery and had the fewest variables.Trial Registration: https://cris.nih.go.kr/cris/index.jsp(KCT0004182). Date of registration:12 august 2019.

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“…This is both an unusually high repetition dose and a short recovery time. There are reports of reduced recovery time in patients with hyperparathyroidism, anticonvulsant drug treatment or long lasting steroid therapy [4][5][6], whereas a prolonged recovery time may be expected in patients suffering from liver cirrhosis or renal failure [2,3]. None of these conditions apply to our patient.…”

Section: Discussionmentioning

confidence: 76%

Are There Rocuronium Rapid Metabolizers? A Case Report on the Importance of Neuromuscular Monitoring

Grabert¹

2020

JAICM

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A healthy 34-year-old female was scheduled for laparoscopic hysterectomy and adnectomy under general anesthesia, combined with an epidural catheter. Throughout surgery, she required and received unusual high doses of rocuronium in unusual short intervals (1mg/kg/h) to maintain adequate neuromuscular block as confirmed by continuous neuromuscular monitoring. Also, despite a functioning epidural catheter, the patient required high doses of remifentanil. This case emphasizes the importance of neuromuscular monitoring in every patient receiving neuromuscular blocking agents. It also raises the question if there are unknown influences or different mechanisms of metabolism.

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Reduced duration of muscle relaxation with rocuronium in a normocalcemic hyperparathyroid patient

Cited by 12 publications

References 11 publications

Comparison of the TOFscan and the TOF-Watch SX during pediatric neuromuscular function recovery: a prospective observational study

Comparison of the TOFscan and the TOF-Watch SX during pediatric neuromuscular function recovery: a prospective observational study

Comparison of Neuromuscular Blockade Recovery Co-Administered With Neostigmine and Different Doses of Calcium Gluconate: A Randomized Control Trial

Are There Rocuronium Rapid Metabolizers? A Case Report on the Importance of Neuromuscular Monitoring

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