Saline Flush After Rocuronium Bolus Reduces Onset Time and Prolongs Duration of Effect

Ishigaki, Sayaka; Masui, Kenichi; Kazama, Tomiei

doi:10.1213/ane.0000000000001094

Cited by 16 publications

(10 citation statements)

References 11 publications

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“…A study conducted by Ishigaki et al . [ 6 ] among 48 patients on the effect of 20 ml saline flush immediately after rocuronium 0.6 mg/kg administration reported that the lag time and onset time were shortened to 39 ± 11 s and 73 ± 21 s in the study group compared to 46 ± 10 s and 87 ± 22 s in the control along with prolongation of the recovery phase of neuromuscular blockade. Nitahara et al .…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 ] There is limited evidence with two studies in which 20 ml saline flush immediately after administration of neuromuscular blockers followed by limb elevation which shortened the lag time and onset time in the study group compared to control group. [ 6 7 ] One of the earliest reports conclude that administration of vecuronium into a pulmonary artery significantly shortened the onset time by approximately 40 s than when compared to administration into a dorsal vein of the hand. [ 8 ]…”

Section: Introductionmentioning

confidence: 99%

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The role of bolus injection of saline with arm elevation on rocuronium onset time: A randomized control study

2018

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Background:The onset time of neuromuscular blockade is a crucial time associated with the risk of hypoxia and pulmonary aspiration. Various strategies have been undertaken to shorten this onset time. Therefore, we investigated the effects of bolus of 20 ml saline followed by limb elevation after administration of rocuronium in a dose of 0.6 mg/kg to study the onset time.Methodology:Thirty patients were randomly allocated to the bolus saline group or control group. General anesthesia was induced and maintained with fentanyl and propofol. Rocuronium 0.6 mg/kg intravenous (IV) was administered followed by 20 ml saline bolus and limb elevation in the study group compared to administration of 0.6 mg/kg in a running drip only in the control. Onset of neuromuscular block was assessed by acceleromyography at the adductor pollicis muscle with train-of-four stimulation.Results:The lag time was shorter in bolus group (34 s median) than in control group (45 s median), P < 0.017. The onset time was shorter in bolus group (55 s median) than in control group (110 s median), P < 0.001. The T1 recovery to 25% was longer in bolus group (42 min median) than in control group (39 min median) which was statistically not significant.Conclusion:Rocuronium 0.6 mg/kg IV followed by bolus 20 ml saline and concomitant limb elevation resulted in shorter lag time, faster onset of neuromuscular blockade, good intubating conditions without prolonging clinical duration of action when compared to the control.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The role of bolus injection of saline with arm elevation on rocuronium onset time: A randomized control study

2018

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“…It should be noted that anesthetic is crucial role for MEP recording and classification, so all consecutive patients underwent the same anesthesia regime. MEP baseline must be recorded after performing the rocuronium of more than 50 min [23]. The patients with different TOF might affect the MEP responses, even using total intravenous anesthesia (TIVA), thus within 100 ± 5% TOF changes were confirmed when recording MEP baseline (Fig.…”

Section: Anesthesia Managementmentioning

confidence: 99%

The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients

et al. 2020

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Background: Surgery is usually the treatment of choice for patients with cervical compressive myelopathy (CCM). Motor evoked potential (MEP) has proved to be helpful tool in evaluating intraoperative cervical spinal cord function change of those patients. This study aims to describe and evaluate different MEP baseline phenotypes for predicting MEP changes during CCM surgery. Methods: A total of 105 consecutive CCM patients underwent posterior cervical spine decompression were prospectively collected between December 2012 and November 2016. All intraoperative MEP baselines recorded before spinal cord decompression were classified into 5 types (I to V) that were carefully designed according to the different MEP parameters. The postoperative neurologic status of each patient was assessed immediately after surgery. Results: The mean intraoperative MEP changes range were 10.2% ± 5.8, 14.7% ± 9.2, 54.8% ± 31.9, 74.1% ± 24.3, and 110% ± 40 in Type I, II, III, IV, and V, respectively. There was a significant correlation of the intraoperative MEP change rate with different MEP baseline phenotypes (r = 0.84, P < 0.01). Postoperative transient new spinal deficits were found 0/31 case in Type I, 0/21 in Type II, 1/14 in Type III, 2/24 in Type IV, and 4/15 in Type V. No permanent neurological injury was found in our cases series. Conclusions: The MEP baselines categories for predicting intraoperative cervical cord function change is proposed through this work. The more serious the MEP baseline abnormality, the higher the probability of intraoperative MEP changes, which is beneficial to early warning for the cervical cord injury.

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“…Among these are priming principle, timing principle and using high doses [5]. It has been reported in the literature that especially saline flush immediately after intravenous drug administration shortens the onset time [6,7]. Studies in the literature recommend 20 mL saline flush to be administered after adenosine, a drug with a half-life of shorter than 10 seconds and administered via a peripheral vein, to rapidly reach to the heart [6].…”

Section: Introductionmentioning

confidence: 99%

“…Studies in the literature recommend 20 mL saline flush to be administered after adenosine, a drug with a half-life of shorter than 10 seconds and administered via a peripheral vein, to rapidly reach to the heart [6]. Ishigaki et al [7] have demonstrated that 20 mL saline flush administration immediately after intravenous administration of rocuronium shortens the onset time of the drug. To the best of our knowledge, this is the first study investigating the effect of saline flush administered immediately after sugammadex on the onset time of this drug using TOF monitoring.…”

Section: Introductionmentioning

confidence: 99%

Effect of saline flush on the onset time of sugammadex: A randomized clinical study

Yoldaş¹,

Karagöz²

2020

Journal of Surgery and Medicine

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Aim: Several methods have been tried out to shorten the onset time of sugammadex. The objective of this study was to examine the effect of 20 mL saline flush administered immediately after sugammadex on its onset time by using train-of-four (TOF) monitoring. Methods: This study was initiated after obtaining the approval of the institutional Medical Research Ethics Committee. A total of 60 ASA I-II patients aged between 18-65 years scheduled for elective abdominal surgery in our hospital between August 2017 and January 2018, which would last 1-3 hours under general anesthesia, were enrolled in this study. Patients were randomly divided into two groups as Group S (saline flush group, n=30) and Group C (control group, n=30). Saline flush group received 2 mg/kg sugammadex and 20 ml isotonic saline flush immediately after sugammadex administration, while the control group received 2 mg/kg sugammadex only. TOF monitoring was used to assess neuromuscular block. Electrocardiography, oxygen saturation, noninvasive arterial pressure as well as acceleromyography values measured by TOF monitoring device were recorded and compared between the groups. All patients were continuously monitored intraoperatively and 30 minutes postoperatively. Results: Both groups were similar in terms of basic clinical characteristics and demographics. There was a statistically significant difference between the groups in terms of the time of TOF to reach 0.9 from 0.2. The mean time of TOF to reach 0.9 from 0.2 was lower in Saline flush group than in control group (85.4 vs 130.5 seconds; P=0.001). Conclusion: Our study demonstrated that 20 mL saline flush administered immediately after sugammadex shortened the onset time of sugammadex.

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Saline Flush After Rocuronium Bolus Reduces Onset Time and Prolongs Duration of Effect

Abstract: Administering a 20-mL saline flush immediately after infusion of 0.6 mg/kg rocuronium in 10 mL normal saline shortened the onset time and prolonged the recovery phase of neuromuscular blockade.

Cited by 16 publications

References 11 publications

The role of bolus injection of saline with arm elevation on rocuronium onset time: A randomized control study

The role of bolus injection of saline with arm elevation on rocuronium onset time: A randomized control study

The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients

Effect of saline flush on the onset time of sugammadex: A randomized clinical study

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