Retrospective analysis of spontaneous recovery from neuromuscular blockade produced by empirical use of rocuronium

Yamamoto, Hiroto; Uchida, Tatsuo; Yamamoto, Youichi; Ito, Yusuke; Makita, Koshi

doi:10.1007/s00540-011-1229-x

Cited by 6 publications

(4 citation statements)

References 18 publications

(20 reference statements)

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“…Yamamoto et al. () also showed that even though the majority of patients recover from rocuronium blockade within 1 hr from the last administration, more than one‐third of the patients needed from 1 to 2 hr to recover from neuromuscular blockade. Even more, Claudius, Skovgaard, and Viby‐Mogensen () studied the arm‐to‐arm variation in neuromuscular monitoring in the same patients using acceleromyography under controlled procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, it has been reported an important influence of individual variation in neuromuscular blockade in people and dogs after the administration of vecuronium, atracurium, rocuronium and cis‐atracurium (Adams, Robinson, Senior, & Jones, ; Clutton, ; Dabaene, Plaud, Dilly, & Donati, ; Varposhti, Heidari, Safavi, Honarmand, & Raeesi, ; Yamamoto, Uchida, Yamamoto, Ito, & Makita, ). In dogs, cis‐atracurium duration of action ranged from 5 to 50 min after a single 0.1 mg/kg dose.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Neuromuscular block monitoring after the administration of 1 mg/kg intravenous cis‐atracurium in the anaesthetized pig

Aguilar

Moll

García

et al. 2018

Vet Pharm & Therapeutics

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Neuromuscular blocking agents should be included as part of a balanced anaesthetic protocol to improve anaesthetic management, although doses are not always established for each species. Cis-atracurium is a benzylisoquinolinium neuromuscular blocking agent with an intermediate duration of action devoid of significant adverse effects previously used in pigs with a wide dosage range. Cis-atracurium was administered at 1 mg/kg bolus to sixteen pigs to establish its time profile and effects. The pigs were premedicated intramuscularly with 4 mg/kg azaperone, 8 mg/kg ketamine and 0.2 mg/kg morphine IM and maintained with isoflurane in oxygen. After cis-atracurium administration, neuromuscular monitoring via acceleromyography was started until the recovery of the 90% of the train of four ratio. Complete decrease in the train of four ratio was accomplished in eleven pigs. Onset of action was 70 s, with a recovery of the fourth twitch at 26 min and a recovery of a train of four ratio greater than 90% in 60 min. In conclusion, 1 mg/kg intravenous cis-atracurium in the pig allowed for a rapid onset of action and a complete recovery after 60 min although high variability in the time profile is seen.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neuromuscular block monitoring after the administration of 1 mg/kg intravenous cis‐atracurium in the anaesthetized pig

Aguilar

Moll

García

et al. 2018

Vet Pharm & Therapeutics

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“…The earliest study concerning pharmacokinetics of this agent [21] showed that in patients over 70 the mean time to spontaneous recovery to 90% of the baseline muscle response measured at the adductor pollicis muscle to a single supramaximal stimulus was 74.4 minutes as compared to 47.9 in patients between 27-58 years of age. Yamamoto et al [22] demonstrated that within 1−2 hours of administration of the last maintenance dose of rocuronium, or from the discontinuation of the infusion, TOFR values were < 0.9 in as many as 75% patients of 65−85 years of age, and only in 33% subjects aged 20−48. The relationship between the duration of neuromuscular blockade after an intubation dose of rocuronium and patient age is even more pronounced in cases of renal failure [23].…”

Section: Aminosteroidsmentioning

confidence: 99%

Blokada nerwowo-mięśniowa u osób w podeszłym wieku

Stankiewicz-Rudnicki

2016

Anaesthesiol Intensive Ther

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The aim of the presented review is to highlight the clinical problem of postoperative residual curarization (PORC) following general anaesthesia in the elderly. Possible complications of PORC are described along with age-induced changes in pharmacokinetics of long and intermediate-acting neuromuscular blocking agents. This is intended to facilitate the selection and to promote appropriate intraoperative use of muscle relaxants in patients over the age of 65 years.Key words: elderly patients; neuromuscular block, muscle relaxants; neuromuscular block, reversal; postoperative residual curarization Anaesthesiology Intensive Therapy 2016, vol. 48, no 4, 257-260 Anaesthesiologists are regularly involved in the treatment of elderly patients due to the increasing life expectancy and rising number of surgeries in the aging population [1]. General anaesthesia comprises four crucial components: unconsciousness, analgesia, immobilization and haemodynamic stability [2]. Neuromuscular block serves the two latter purposes. As it maintains good surgical conditions as well as facilitating airway management, doses of both volatile and intravenous anaesthetics can be considerably reduced. This is of importance in patients over 65 years of age, particularly those older than 75. This group of patients is most susceptible to the adverse effects of anaesthetics [3], including decreased heart muscle contractility and hypotension, which pose a risk of cardiac and central nervous system ischaemia [4].Unfortunately, advanced age is accompanied by an increasing risk of postoperative residual curarization (PORC) [5] which, along with intraoperative awareness [6], is one of the most clinically significant complications of the use of muscle relaxants. Residual blockade is currently defined by the train of four ratio (TOFR) < 0.9, although previous reports mentioned TOFR < 0.7. It may lead to severe respiratory complications in the post-operative period [7], and thus prolong hospitalization. Awareness of the specific issues of neuromuscular blocking agents use in the elderly is therefore crucial in daily anaesthesiological practice. CliniCal aspeCts of the pharmaCokinetiCs of neuromusCular bloCking agents in the elderlyDoses of both steroid and benzylisoquinoline-derived non-depolarising muscle relaxants necessary to reach maximal block, i.e. 95% reduction of muscle response to a stimulus (effective dose 95 , ED 95 ), do not vary significantly between elderly persons and younger subjects [8,9]. This suggests that the physiology of the neuromuscular junction and the pharmacodynamics of neuromuscular blocking agents are not markedly altered in advanced age. It is the pharmacokinetics of these agents that is responsible for their altered clinical effects in the elderly.Decreased cardiac output is accompanied by reduced skeletal muscle perfusion [3] and, consequently, one should expect a prolonged time to maximum blockade following drug administration [10,11]. However, doses of muscle relaxants used for intubation are two to three, or ...

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“…Furthermore, using intraoperative NMBAs may result in postoperative residual neuromuscular block, which can increase postoperative pulmonary complications [6]. Although there have been conflicting results regarding the association between age and postoperative residual Ivyspring International Publisher neuromuscular block [7][8][9], some studies have found that the incidence of postoperative residual neuromuscular block increases with age [8,9], occurring more frequently in older adults than in younger patients [6].…”

Section: Introductionmentioning

confidence: 99%

Effects of neuromuscular blocking agents on the clinical performance of i-gel^® and surgical condition in elderly patients undergoing hand surgery: a prospective randomized controlled trial

et al. 2021

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Retrospective analysis of spontaneous recovery from neuromuscular blockade produced by empirical use of rocuronium

Abstract: Because of the large variation in the recovery from rocuronium-induced paralysis, TOF-based evaluation of residual paralysis is essential to determine the appropriate indication for reversal, especially for elderly patients.

Cited by 6 publications

References 18 publications

Neuromuscular block monitoring after the administration of 1 mg/kg intravenous cis‐atracurium in the anaesthetized pig

Neuromuscular block monitoring after the administration of 1 mg/kg intravenous cis‐atracurium in the anaesthetized pig

Blokada nerwowo-mięśniowa u osób w podeszłym wieku

Effects of neuromuscular blocking agents on the clinical performance of i-gel^® and surgical condition in elderly patients undergoing hand surgery: a prospective randomized controlled trial

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Retrospective analysis of spontaneous recovery from neuromuscular blockade produced by empirical use of rocuronium

Abstract: Because of the large variation in the recovery from rocuronium-induced paralysis, TOF-based evaluation of residual paralysis is essential to determine the appropriate indication for reversal, especially for elderly patients.

Cited by 6 publications

References 18 publications

Neuromuscular block monitoring after the administration of 1 mg/kg intravenous cis‐atracurium in the anaesthetized pig

Neuromuscular block monitoring after the administration of 1 mg/kg intravenous cis‐atracurium in the anaesthetized pig

Blokada nerwowo-mięśniowa u osób w podeszłym wieku

Effects of neuromuscular blocking agents on the clinical performance of i-gel® and surgical condition in elderly patients undergoing hand surgery: a prospective randomized controlled trial

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Product

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Effects of neuromuscular blocking agents on the clinical performance of i-gel^® and surgical condition in elderly patients undergoing hand surgery: a prospective randomized controlled trial