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x
- MeSH
- Anaphylaxis epidemiology physiopathology prevention & control MeSH
- Androstanols administration & dosage pharmacology MeSH
- Balanced Anesthesia methods MeSH
- Muscle Relaxants, Central administration & dosage pharmacology MeSH
- Neuromuscular Depolarizing Agents administration & dosage pharmacology adverse effects MeSH
- Humans MeSH
- Succinylcholine administration & dosage pharmacology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
BACKGROUND: Rocuronium for cesarean delivery under general anesthesia is an alternative to succinylcholine for rapid-sequence induction of anesthesia because of the availability of sugammadex for reversal of neuromuscular blockade. However, there are no large well-controlled studies in women undergoing general anesthesia for cesarean delivery. The aim of this noninferiority trial was to determine whether rocuronium and sugammadex confer benefit in time to tracheal intubation (primary outcome) and other neuromuscular blockade outcomes compared with succinylcholine, rocuronium, and neostigmine in women undergoing general anesthesia for cesarean delivery. METHODS: We aimed to enroll all women undergoing general anesthesia for cesarean delivery in the 2 participating university hospitals (Brno, Olomouc, Czech Republic) in this single-blinded, randomized, controlled study. Women were randomly assigned to the ROC group (muscle relaxation induced with rocuronium 1 mg/kg and reversed with sugammadex 2-4 mg/kg) or the SUX group (succinylcholine 1 mg/kg for induction, rocuronium 0.3 mg/kg for maintenance, and neostigmine 0.03 mg/kg for reversal of the neuromuscular blockade). The interval from the end of propofol administration to tracheal intubation was the primary end point with a noninferiority margin of 20 seconds. We recorded intubating conditions (modified Viby-Mogensen score), neonatal outcome (Apgar score <7; umbilical artery pH), anesthesia complications, and subjective patient complaints 24 hours after surgery. RESULTS: We enrolled 240 parturients. The mean time to tracheal intubation was 2.9 seconds longer in the ROC group (95% confidence interval, -5.3 to 11.2 seconds), noninferior compared with the SUX group. Absence of laryngoscopy resistance was greater in the ROC than in the SUX groups (ROC, 87.5%; SUX, 74.2%; P = 0.019), but there were no differences in vocal cord position (P = 0.45) or intubation response (P = 0.31) between groups. No statistically significant differences in incidence of anesthesia complications or in neonatal outcome were found (10-minute Apgar score <7, P = 0.07; umbilical artery pH, P = 0.43). The incidence of postpartum myalgia was greater in the SUX group (ROC 0%; SUX 6.7%; P = 0.007). The incidence of subjective complaints was lower in the ROC group (ROC, 21.4%; SUX, 37.5%; P = 0.007). CONCLUSIONS: We conclude that rocuronium for rapid-sequence induction is noninferior for time to tracheal intubation and is accompanied by more frequent absence of laryngoscopy resistance and lower incidence of myalgia in comparison with succinylcholine for cesarean delivery under general anesthesia.
- MeSH
- Androstanols administration & dosage adverse effects MeSH
- Antidotes administration & dosage adverse effects MeSH
- Time Factors MeSH
- Anesthesia, General * adverse effects MeSH
- Cholinesterase Inhibitors administration & dosage adverse effects MeSH
- Cesarean Section * adverse effects MeSH
- Adult MeSH
- gamma-Cyclodextrins administration & dosage adverse effects MeSH
- Intubation, Intratracheal MeSH
- Single-Blind Method MeSH
- Laryngoscopy MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Myalgia etiology prevention & control MeSH
- Neuromuscular Nondepolarizing Agents administration & dosage adverse effects MeSH
- Neostigmine administration & dosage adverse effects MeSH
- Neuromuscular Blockade adverse effects methods MeSH
- Pain, Postoperative etiology prevention & control MeSH
- Anesthesia, Obstetrical adverse effects methods MeSH
- Succinylcholine administration & dosage MeSH
- Pregnancy MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
- Geographicals
- Czech Republic MeSH
Cíl studie: Srovnání postupů celkové anestezie se zaměřením na svalovou relaxaci v oblastní a fakultní nemocnici. Typ studie: Tříměsíční retrospektivní rozbor anesteziologických záznamů. Typ pracoviště: Anesteziologicko-resuscitační oddělení oblastní nemocnice, klinika anesteziologie, resuscitace a intenzivní medicíny fakultní nemocnice. Materiál a metoda: Během tříměsíčního období (září až listopad 2011) byly sledovány záznamy všech anesteziologických výkonů v oblastní (MB2011) a fakultní (FNOL2011) nemocnici, ve strukturované formě popsány: demografické údaje nemocných, typ a délka anesteziologické péče, zajištění dýchacích cest, svalová relaxace, reverze a monitorování bloku. Data mezi nemocnicemi porovnána (nepárový t-test, Fisherův přesný test, chí-kvadrát) na pětiprocentní hladině významnosti. Výsledky: Počet anesteziologických výkonů MB2011 2886, FNOL2011 4746. Celková anestezie byla poskytnuta častěji ve FNOL2011 (92,5 %) než v MB2011 (55,5 %, p < 0,0001), podíl regionální anestezie, případně s analgosedací činil v MB2011 27,3 %. V MB2011 byly nejčastější výkony kratší 60 minut (69,2 %), ve FNOL2011 výkony delší 60 minut (64,7 %). LMA byla požita častěji v MB2011 (26,5 %) než ve FNOL2011 (14,2 %, p < 0,0001). Více nemocných ve FNOL2011 bylo relaxováno (61,7 %), v MB2011 41,5 %, p < 0,0001. Nejčastějším relaxanciem bylo rokuronium (MB2011 88,5 %, FNOL2011 75,5 %, p < 0,0001). Hloubka relaxace byla monitorována u 52,1 % (MB2011), respektive 8,5 % nemocných (FNOL2011, p < 0,0001). Antagonizace bloku neostigminem u 89,8 % pacientů (MB2011) vs. 18,3 % (FNOL2011, p < 0,0001), průměrná dávka byla 0,024 ? 0,007 mg/kg (MB2011) vs. 0,019 ? 0,025 mg/kg (FNOL2011, p < 0,0001). Závěr: Prokázali jsme rozdíly v postupech anesteziologické péče mezi oblastní a fakultní nemocnicí. Klíčová slova: celková anestezie – dýchací cesty – svalová relaxace – reverze – monitorování
Objective: Comparison of general anaesthesia techniques focused on neuromuscular blockade in a regional and university hospitals. Design: Retrospective study, three-month analysis of anaesthesia charts. Setting: Departments of Anaesthesiology and Intensive Therapy of a regional and university hospitals. Materials and methods: Anaesthetic charts for all anae-stetic procedures performed in a regional (MB2011) and university (FNOL2011) hospitals during a 3-month period (September- November 2011) were analysed, focusing on patients‘ demographic data, type and lenght of anaesthesia, airway maintainance, neuromuscular blockade, techniques of block reversal and monitoring. The data were compared between the hospitals (unpaired t-test, Fisher exact, Chi-squared test) with statistical significance p < 0.05. Results: The total number of anaesthetic procedures performed in MB2011 was 2886, in FNOL2011 4746. General anaesthesia was more frequent in FNOL2011 (92.5%) than in MB2011 (55.5%, p < 0.0001), where 27.3% of procedures were performed in regional anaesthesia (alone or supplemented with analgosedation). Procedures lasting less than 60 minutes were more frequent in MB2011 (69.2%), whereas in FNOL2011 procedures lasting over 60 minutes prevailed (64.7%). LMA was used more often in MB2011 (26.5%) than in FNOL2011 (14.2%, p < 0.0001) for airway maintenance. Neuromuscular blockade was utilised more often in FNOL2011 (61.7%) than in MB2011 (41.5%, p < 0.0001). Rocuronium was the most frequently used NMBA (MB2011 88.5%, FNOL 75.5%, p < 0.0001). Depth of blockade was monitored in 52.1% patients in MB2011, compared to 8.5% patients in FNOL2011, p < 0.0001). Neuromuscular blockade was reversed with neostigmine in 89.8% patients (MB2011) vs. 18.3% (FNOL2011, p < 0.0001), with mean dose of 0.024 ? 0.007 mg/kg (MB2011) vs. 0.019 ? 0.025 mg/kg (FNOL2011, p < 0.0001). Conclusion: We observed differences in anaesthesia care procedures between a regional and university hospitals. Keywords: general anaesthesia – airway – neuromuscular blockade – reversal – monitoring
- Keywords
- reverze,
- MeSH
- Conscious Sedation statistics & numerical data MeSH
- Androstanols administration & dosage MeSH
- Time Factors MeSH
- Anesthesia, General * methods statistics & numerical data MeSH
- Muscle Relaxants, Central administration & dosage MeSH
- Surgical Procedures, Operative classification statistics & numerical data MeSH
- Anesthetics, Combined MeSH
- Laparoscopy statistics & numerical data MeSH
- Laryngeal Masks statistics & numerical data MeSH
- Humans MeSH
- Neuromuscular Nondepolarizing Agents administration & dosage MeSH
- Hospitals, Teaching * MeSH
- Hospitals, District * MeSH
- Neostigmine administration & dosage MeSH
- Neuromuscular Blocking Agents administration & dosage MeSH
- Monitoring, Intraoperative statistics & numerical data MeSH
- Health Care Surveys statistics & numerical data MeSH
- Retrospective Studies MeSH
- Rocuronium MeSH
- Chi-Square Distribution MeSH
- Statistics as Topic MeSH
- Anesthesia, Conduction methods statistics & numerical data MeSH
- Airway Management methods statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Publication type
- Comparative Study MeSH
- MeSH
- Androstanols administration & dosage pharmacology therapeutic use MeSH
- Anesthesia, General methods MeSH
- Cesarean Section MeSH
- Financing, Organized MeSH
- gamma-Cyclodextrins administration & dosage pharmacology therapeutic use MeSH
- Advertising MeSH
- Humans MeSH
- Neuromuscular Nondepolarizing Agents * administration & dosage pharmacology therapeutic use MeSH
- Neuromuscular Blockade methods MeSH
- Neuromuscular Agents antagonists & inhibitors administration & dosage therapeutic use MeSH
- Labor, Obstetric drug effects MeSH
- Anesthesia, Obstetrical * methods MeSH
- Muscle Relaxation drug effects MeSH
- Check Tag
- Humans MeSH
- Female MeSH
Cíl: Zjistit rozsah použití myorelaxancií (NMBAs) v operačních oborech. Typ studie:Tříměsíční unicentrická retrospektivní observační studie rozborem anesteziologických záznamů (MBrelax2008). Pracoviště: Anesteziologicko-resuscitační oddělení regionální nemocnice. Materiál a metody: V operačních oborech sledovány – četnost celkové (CA) a regionální anestezie (RA), po - užití suxamethonia a nedepolarizujících NMBAs. Získané údaje porovnány s výsledky průřezové jednodenní národní studie Czech Anesthesia Day (CAD2010). Výsledky: Vyhodnoceno 2316 anesteziologických záznamů ze sledovaného období. CA podána v 72,6 % (CAD2010 92,9 %, p < 0,0001), nejčastěji na ORT/TRAUM (366; 48,8 %), CHIR (343; 80,3 %), URO (248; 72,9 %), ORL (306; 100 %), GPO (406; 84,4 %) a OČNÍM (12; 100 %). NMBAs použita u 634 pacientů (37,7% vs. 54,7% in CAD2010, p < 0,0001)), nejčastěji v CHIR (271; 79 %). LMA bez NMBA zavedena u 478 (28,4 %) pacientů, samotné suxamethonium použito u 33 pacientů (2 % CA), nejčastěji na GPO. Jen nedepolarizující NMBA u 471 pacientů (28 % CA) vs. u 684 (36,1 % CA) v CAD2010, p < 0,0001. Rokuronium použito častěji než cis - atrakurium (20,8 % vs. 13,8 %, p < 0,0001). Závěr: Ve srovnání s CAD2010 byl podíl výkonů v CA nižší a odráží častější použití RA. Rovněž počty relaxovaných pacientů byly nižší. Častěji byla používána LMA bez svalové relaxace. Z NMBAs bylo nejčastěji použito rokuronium. Výsledky ukazují na obtíže při interpretaci a porovnávání výsledků multicentrických průřezových studií stávající klinické praxe. Sledování anesteziologické péče je vhodné v delším časovém období a v menším počtu srovnatelných center.
Objective: Use of NMBAs in surgical anaesthesia. Design: Single-center, three-month analysis of anaesthesia charts (MBrelax2008). Setting: Department of Anaesthesiology and Intensive Care of a regional general hospital. Materials and methods:The observed parameters in surgical anaesthesia included the use of general anae - sthesia (GA), regional anaesthesia (RA), suxamethonium and non-depolarising NMBAs. The results were compared to data from the observational one-day Czech Anesthesia Day (CAD2010). Results: Total 2316 anaesthesia charts from the observed period were evaluated. GA was used in 72.6 % (CAD2010 92.9 %, p < 0.0001). Orthopaedics/Trauma (366; 48.8 %), General Surgery (343; 80.3 %), Urology (248; 72.9 %), ENT (306; 100 %), Gynae/Obstetrics (406; 84.4 %) and Ophthalmology (12; 100 %). NMBAs were administered to 634 patients (37.7% vs 54.7% in CAD2010, p < 0.0001), most often in G/S (271; 79 %). LMA was inserted without facilitation by NMBAs in 478 (28.4 %) patients. Suxamethonium alone was used in 33 patients (2 % GA) only, most frequently in G/O. In the MBrelax2008 study, non-depolarizing NMBAs only were administered to 471 patients (28 % GA) vs. 684 (36.1% GA) in CAD2010 (p < 0.0001). Rocuronium was administered more often than cisatracurium (20.8 % vs. 13.8 %, p < 0.0001). Conclusion: Comparing with CAD2010, surgery was performed under GA less frequently, reflecting increasing preference of RA in the center. This correlates with the lower use of NMBAs. LMA were more often inserted without NMBAs. Rocuronium is the most frequently used NMBA. The results point to the difficulties experienced when comparing the data from observational multi-center studies with current clinical practice. The data should be evaluated for longer periods and comparable centers.
- Keywords
- regionální anestezie, farmakoekonomika, NMBA, suxamethonium, cisatrakurium,
- MeSH
- Androstanols administration & dosage MeSH
- Atracurium analogs & derivatives administration & dosage MeSH
- Anesthesia, General methods statistics & numerical data MeSH
- Muscle Relaxants, Central administration & dosage MeSH
- Surgical Procedures, Operative MeSH
- Data Interpretation, Statistical MeSH
- Laryngeal Masks statistics & numerical data MeSH
- Humans MeSH
- Neuromuscular Nondepolarizing Agents administration & dosage MeSH
- Hospital Departments MeSH
- Neuromuscular Blocking Agents administration & dosage therapeutic use MeSH
- Health Care Surveys statistics & numerical data MeSH
- Retrospective Studies MeSH
- Rocuronium MeSH
- Statistics as Topic MeSH
- Succinylcholine administration & dosage MeSH
- Anesthesia, Conduction methods statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Publication type
- Comparative Study MeSH
- Geographicals
- Czech Republic MeSH
Cíl studie: Získání poznatků o způsobu použití svalových relaxancií (NMBA) během celkové anestezie u kardiochirurgických operací dospělých pacientů v České republice. Typ studie: Prevalenční pětidenní dotazníková studie. Typ pracoviště: Pracoviště poskytující anesteziologickou péči u kardiochirurgických operací dospělých, která se zaregistrovala před termínem studie. Materiál a metoda: Do studie byl zahrnut každý pacient na registrovaném pracovišti, kde byla zahájena anesteziologická péče v období od 6. června 2011 v 7:00 hodin do 11. června v 7:00 hodin. Údaje o každém pacientovi byly vkládány do internetového formuláře. Sledované údaje zahrnovaly parametry se vztahem k svalové relaxaci (použití NMBA, antagonizace bloku, monitorování relaxace), základní demografické údaje, data o podané anestezii (typ výkonu, použití mimotělního oběhu, způsob zajištění dýchacích cest) a data o pooperačním průběhu (čas extubace). Výsledky: Do studie bylo zahrnuto 183 pacientů. S použitím mimotělního oběhu bylo provedeno 132 výkonů. K tracheální intubaci (provedena u 172 pacientů) bylo nejčastěji použito rokuronium (31,1 %), pankuronium (16,9 %), atrakurium (14,8 %) a cisatrakurium (13,7 %), méně vekuronium (10,9 %), minimálně pipekuronium (3,3 %) a mivakurium (1,1 %). Suxamethonium bylo použito u 4 pacientů (2,2 %) a u 11 pacientů nebylo v úvodu použito žádné relaxans. Během vedení anestezie bylo nejčastěji použito: rokuronium (24,0 %), cisatrakurium (15,8 %), pankuronium (12,0 %), atrakurium (10,9%) a vekuronium (11,5%), u 43 pacientů (23,5%) nebylo během vedení používáno žádné NMBA. V 61 případech bylo NMBA podáváno kontinuálně, 41 dostalo jediný bolus, 37 opakované bolusy. Reverze blokády nebyla provedena. Monitorování relaxace nebylo použito.
Objective: To obtain data about the use of neuromuscular blocking agents (NMBAs) during general anaesthesia in adult patients undergoing cardiac surgery in the Czech Republic. Design: A five-day, prevalence, questionnaire study. Setting: All cardiac anesthesia departments that registered before the study date. Materials and methods: Patients whose anesthetic care was provided between June 6 (7 AM) and June 11 (7 AM) were enrolled. Data of each patient were entered into a web-based questionnaire and information relevant to neuromuscular blockade was collected. Results: During the study period, 183 patients (173 on cardiopulmonary bypass) were anesthetized. Tracheal intubation (172 patients) was facilitated most often by non-depolarizing NMBAs: rocuronium (31.1%), pancuronium (16.9%), atracurium (14.8%), cisatracurium (13.7%), and suxamethonium 2.2%. Neuromuscular blockade was maintained most frequently with rocuronium (24.0%), cisatracurium (15.8%), pancuronium (12.0%), atracurium (14.8%), and vecuronium (11.5%). Neuromuscular blockade was not reversed in any patient. Monitoring of neuromuscular blockade was not used in any patient. Conclusion: For induction and maintenance of neuromuscular blockade, predominantly intermediate NMBAs were used. In the Czech Republic, neither neuromuscular blockade monitoring nor pharmacological reversal is used during cardiac surgery in adult patients.
- Keywords
- dotazníková studie, kardiochirurgie, svalové relaxans, antagonizace, monitorování,
- MeSH
- Androstanols administration & dosage MeSH
- Anesthesia Department, Hospital MeSH
- Atracurium analogs & derivatives administration & dosage MeSH
- Anesthesia, General methods statistics & numerical data MeSH
- Adult MeSH
- Airway Extubation methods statistics & numerical data MeSH
- Cardiac Surgical Procedures MeSH
- Middle Aged MeSH
- Humans MeSH
- Longitudinal Studies MeSH
- Neuromuscular Nondepolarizing Agents administration & dosage therapeutic use MeSH
- Neuromuscular Blockade methods MeSH
- Neuromuscular Blocking Agents administration & dosage therapeutic use MeSH
- Pancuronium administration & dosage MeSH
- Monitoring, Intraoperative MeSH
- Anesthesia Recovery Period MeSH
- Surveys and Questionnaires MeSH
- Aged MeSH
- Statistics as Topic MeSH
- Hypothermia, Induced MeSH
- Airway Management methods statistics & numerical data MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Geographicals
- Czech Republic MeSH
Cíl studie: Srovnání farmakodynamiky rokuronia (0,6 mg . kg-1) u mladších a starších nemocných obou pohlaví během totální intravenózní anestezie. Typ studie: Klinická, observační, bez zaslepení. Typ pracoviště: Klinika anesteziologie, resuscitace a intenzivní medicíny fakultní nemocnice. Materiál a metoda: Po schválení etickou komisí a informovaném souhlasu nemocných jsme vyšetřovali nemocné, operované v totální intravenózní anestezii (propofol/sufentanil). U 37 mužů ve věku 20–40 let (skupina A), 40 mužů (60–75 let, skupina B), 43 žen (20–40 let, skupina C), 38 žen (60–75 let, skupina D) jsme monitorovali svalovou relaxaci po podání rokuronia (0,6 mg . kg-1): stimulace n. ulnaris v režimu TOF v 15sekundových intervalech, sledování EMG odpovědi m. adductor pollicis. U každého nemocného jsme stanovili rychlost nástupu účinku (od aplikace rokuronia do maximální deprese T1), délku klinického účinku (od aplikace rokuronia do 25% zotavení T1) a interval do plného zotavení (od aplikace do TOF-ratio ≥ 0,90). Skupiny jsme porovnali Kruskal-Wallisovým testem na 5% hladině významnosti. Výsledky: Rychlost nástupu účinku (medián [IQR]) byla ve skupinách A, B, C, D 90 [80–110]BCD, 135 [116–165]AC, 75 [60–90]ABD a 120 [90–146]AC sekund. Délka klinického účinku byla 30 [25–42]BCD, 58 [53–67]AD, 50 [40–65]AD a 85 [70–90]ABC min. Interval do spontánního zotavení byl 59 [51–67]BCD, 102 [75–106]A, 76 [66–91]AD a 128 [94–137]AC min. (AP < 0,05 vs. mladší muži, BP < 0,05 vs. starší muži, CP < 0,05 vs. mladší ženy, DP < 0,05 vs. starší ženy). Závěr: Ženy a starší nemocní jsou citlivější k účinku rokuronia podaného v jedné dávce (0,6 mg . kg-1).
Objective: To compare the pharmacodynamics of 0.6 mg . kg-1 rocuronium in young and older patients of both genders during total intravenous anaesthesia. Design: Clinical, observational, non-blinded study. Setting: Department of Anaesthesiology, University Hospital. Materials and methods: Following local ethics committee approval and informed consent, patients scheduled for surgery under total intravenous anesthesia (propofol/sufentanil) were divided into 4 study groups: 37 males aged 20–40, 40 males aged 60–75 yrs, 43 females aged 20–40 and 38 females aged 60–75 yrs. Neuromuscular block following rocuronium (0.6 mg kg-1) was monitored as follows: train-of-four [TOF] stimulation of the ulnar nerve at 15-s intervals, EMG of the adductor pollicis muscle. The onset time (from application of rocuronium to maximum depression of T1), clinical duration (from application to 25% recovery of T1), and time to full spontaneous recovery (from application to TOF-ratio ≥ 0.9) were determined for each pa - tient. The Kruskal-Wallis test was used to compare differences between the groups; P < 0.05 was considered statistically significant. Results: The onset time (median [interquartile range]) in the respective groups was 90 [80–110]BCD, 135 [116–165]AC, 75 [60–90]ABD, and 120 [90–146]AC seconds. The clinical duration was 30 [25–42]BCD, 58 [53–67]AD, 50 [40–65]AD, and 85 [70–90]ABC min. The interval to full spontaneous recovery was 59 [51–67]BCD, 102 [75–106]A, 76 [66–91]AD, and 128 [94–137]AC min. (AP<0.05 vs. young males, BP<0.05 vs. elderly males, CP<0.05 vs. young females, DP<0.05 vs. elderly females). Conclusion: Females and the elderly were more sensitive to rocuronium.
- Keywords
- věk,
- MeSH
- Androstanols administration & dosage pharmacokinetics pharmacology MeSH
- Anesthesia Department, Hospital MeSH
- Anesthesia, General methods MeSH
- Adult MeSH
- Electric Stimulation methods instrumentation MeSH
- Financing, Organized MeSH
- Anesthesia, Intravenous methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Neuromuscular Nondepolarizing Agents administration & dosage adverse effects therapeutic use MeSH
- Neuromuscular Blockade methods adverse effects MeSH
- Neuromuscular Junction drug effects MeSH
- Monitoring, Intraoperative methods instrumentation statistics & numerical data MeSH
- Sex MeSH
- Postoperative Complications chemically induced MeSH
- Prospective Studies MeSH
- Sex Distribution MeSH
- Drug Administration Schedule MeSH
- Sex Factors MeSH
- Aging physiology metabolism MeSH
- Age Factors MeSH
- Age Distribution MeSH
- Dose-Response Relationship, Drug MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
Aims. To compare the pharmacodynamics of 0.6 mg kg-1 rocuronium in young and older patients of both genders during total intravenous anesthesia. Methods. Following local ethics committee approval and informed consent, patients scheduled for surgery under total intravenous anesthesia (propofol/sufentanil) were divided into 4 study groups: 37 males aged 20-40, 40 males aged 60-75 yrs, 43 females aged 20-40 and 38 females aged 60-75 yrs. Neuromuscular block following rocuronium (0.6 mg kg-1) was monitored: train-of-four [TOF] stimulation of the ulnar nerve at 15-s intervals, EMG of the adductor pollicis muscle. The onset time (from application of rocuronium to maximum depression of T1), clinical duration (from application to 25% recovery of T1), and time to full spontaneous recovery (from application to TOF-ratio ≥ 0.9) were determined for each patient. The Kruskal-Wallis test was used to compare differences between groups; P<0.05 was considered statistically significant. Results. The onset time (median [interquartile range]) in the respective groups was 90 [80-110]BCD, 135 [116-165]AC, 75 [60-90]ABD, and 120 [90-146]AC seconds. The clinical duration was 30 [25-42]BCD, 58 [53-67]AD, 50 [40-65]AD, and 85 [70-90]ABC min. Interval to full spontaneous recovery was 59 [51-67]BCD, 102 [75-106]A, 76 [66-91]AD, and 128 [94- 137]AC min. (AP<0.05 vs. young males, BP<0.05 vs. elderly males, CP<0.05 vs. young females, DP<0.05 vs. elderly females). Conclusion. Females and older patients were more sensitive to rocuronium.
- MeSH
- Androstanols administration & dosage pharmacokinetics MeSH
- Adult MeSH
- Anesthesia, Intravenous MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Neuromuscular Nondepolarizing Agents administration & dosage pharmacokinetics MeSH
- Neuromuscular Blockade MeSH
- Sex Characteristics MeSH
- Aged MeSH
- Aging metabolism MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Comparative Study MeSH
- MeSH
- Androstanols administration & dosage adverse effects therapeutic use MeSH
- Anesthesia methods adverse effects utilization MeSH
- Anesthesiology history methods trends MeSH
- Muscle Relaxants, Central classification adverse effects therapeutic use MeSH
- gamma-Cyclodextrins therapeutic use MeSH
- Curare administration & dosage adverse effects therapeutic use MeSH
- Humans MeSH
- Meta-Analysis as Topic MeSH
- Neuromuscular Blocking Agents administration & dosage adverse effects therapeutic use MeSH
- Perioperative Period nursing MeSH
- Practice Guidelines as Topic MeSH
- Statistics as Topic MeSH
- Check Tag
- Humans MeSH
- Publication type
- Lecture MeSH
Cíl studie: Popis antagonizace mělkého bloku po rokuroniu podáním sugammadexu. Typ studie: Klinická, observační, retrospektivní, neintervenční. Typ pracoviště: Klinika anesteziologie a resuscitace fakultní nemocnice. Materiál a metoda: Retrospektivně jsme vyhodnotili průběh svalové relaxace po antagonizaci účinku rokuronia sugammadexem (2 mg . kg-1) u nemocných v doplňované anestezii plánované délky 45–60 minut. Nervosvalový přenos jsme měřili přístrojem TOF-Watch® SX (stimulace loketního nervu každých 15 s v režimu TOF, akcelerometrické stanovení odpovědi m. adductor pollicis). Po spontánním zotavení z nervosvalového bloku na TOF-count = 2 jsme podali sugammadex (2 mg . kg-1). Data (TOF-ratio, T1) jsme optickým kabelem přenášeli do počítače, popsali deskriptivními statistickými metodami a znázornili graficky. Výsledky: Analyzovali jsme data od 18 mužů a 14 žen, průměrného věku 46 let, hmotnosti 74 kg, výšky 170 cm a BMI 25,84 kg . m-2. Anestezie trvala průměrně 64 minut. Při spontánním odeznívání bloku se reakce na druhý impulz TOF (TOF-count = 2) objevila při průměrné hodnotě T1 = 19 %. Medián (horní a dolní kvartil) do adekvátního zotavení z bloku (TOF-ratio ? 0,9) byl 97,5 s (75; 130) od podání sugammadexu. Dostatečné zotavení z bloku nastalo u 13 % nemocných do jedné minuty, u 72 % nemocných do 2 minut a u všech nemocných do 3 minut od podání sugammadexu. Nezaznamenali jsme nežádoucí účinky spojené s aplikací sugammadexu. Závěr: Sugammadex (2 mg . kg-1) spolehlivě antagonizuje mělký blok (TOF-count = 2) po podání rokuronia. Adekvátního zotavení se dosáhne do tří minut po aplikaci sugammadexu.
Objective:To study the reversal of moderate rocuronium-induced neuromuscular block as part of balanced general anaesthesia with sugammadex 2 mg/kg. Design: Clinical, observational, retrospective, non-interventional study. Setting: Department of Anaesthesiology, University Hospital. Materials and methods: The reversal of moderate rocuronium-induced neuromuscular block with sugammadex (2 mg/kg) was retrospectively studied. We used TOF stimulation of the ulnar nerve at 15-s intervals and measured the accelerometric response of the adductor pollicis muscle (TOF-Watch® SX). Following spontaneous recovery to TOF-count = 2, sugammadex (2 mg/kg) was administered and the reversal of the block was recorded. We transferred the data (TOF-ratio, T1) via a link to the computer and presented the results using descriptive statistics and graphs. Results:We analysed the data from 18 males and 14 females. The mean age was 46 years, mean weight 74 kg, mean height 170 cm and mean BMI 25.84 kg/m2. The mean duration of anaesthesia was 64 minutes. Du - ring spontaneous recovery from the block, the reaction to the second impulse in TOF (TOF-count = 2) was detected as early as T1 = 19 %. Median (quartiles) of time to full recovery (TOF-ratio ? 0.9) was 97.5 (75; 130) s following sugammadex administration. Full recovery was observed in 13 % patients at 1 minute, in 72 % at 2 minutes and in all the patients at 3 minutes. No adverse effects following sugammadex admini - stration were observed. Conclusion: Following sugammadex (2 mg/kg) administration, the reversal of moderate rocuronium-induced block was reliable and full recovery was reached within 3 minutes of sugammadex administration.
- Keywords
- antagonizace,
- MeSH
- Androstanols administration & dosage therapeutic use MeSH
- Anesthesia, General methods utilization MeSH
- gamma-Cyclodextrins administration & dosage therapeutic use MeSH
- Humans MeSH
- Midazolam administration & dosage therapeutic use MeSH
- Neostigmine administration & dosage adverse effects therapeutic use MeSH
- Neuromuscular Blockade methods utilization MeSH
- Neuromuscular Agents antagonists & inhibitors administration & dosage therapeutic use MeSH
- Propofol administration & dosage therapeutic use MeSH
- Muscle Relaxation drug effects MeSH
- Retrospective Studies MeSH
- Rocuronium MeSH
- Statistics as Topic MeSH
- Sufentanil administration & dosage therapeutic use MeSH
- Sugammadex MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Humans MeSH