Sugammadex Versus Neostigmine After Rocuronium Continuous Infusion in Patients Undergoing Liver Transplantation.

Abstract Background: Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid any postoperative residual block. To date, no study has evaluated sugammadex performance after rocuronium administration in patients undergoing liver transplantation.This is a randomized controlled trial with the primary objective of assessing the neuromuscular transmission recovery time obtained with sugammadex versus neostigmine after rocuronium induced neuromuscular blockade in patients undergoing orthotopic liver transplantation.Methods: The TOF-Watch SX®, calibrated and linked to a portable computer equipped with TOF-Watch SX Monitor Software®, was used to monitor and record intraoperative neuromuscular block maintained with a continuous infusion of rocuronium. Anaesthetic management was standardized as per our institution's internal protocol. At the end of surgery, neuromuscular moderate block reversal was obtained by administration of 2 mg/kg of sugammadex or 50 mcg/kg of neostigmine (plus 10 mcg/kg of atropine). Results: Data from 41 patients undergoing liver transplantation were analysed. In this population, recovery from neuromuscular block was faster following sugammadex administration than neostigmine administration, with mean times±SD of 9.4±4.6 min and 34.6±24.9 min, respectively (p<0.0001). Conclusion: Sugammadex is able to reverse neuromuscular block maintained by rocuronium continuous infusion in patients undergoing liver transplantation. The mean reversal time obtained with sugammadex was significantly faster than that for neostigmine. It is important to note that the sugammadex recovery time in this population was found to be considerably longer than in other surgical settings, and should be considered in clinical practice.Trial registration: ClinicalTrials.gov NCT02697929 (registered 3rd March 2016).

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Sugammadex versus neostigmine after rocuronium continuous infusion in patients undergoing liver transplantation.

10.21203/rs.2.11130/v2 ◽

2020 ◽

Author(s):

CRISTIAN DEANA ◽

Federico Barbariol ◽

Stefano D’Incà’ ◽

Livia Pompei ◽

Giorgio Della Rocca

Keyword(s):

Liver Transplantation ◽

Continuous Infusion ◽

Recovery Time ◽

Neuromuscular Block ◽

Controlled Trial ◽

Anaesthetic Management ◽

Primary Objective ◽

Practice Trial ◽

Reversal Time ◽

Residual Block

Abstract Background Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid any postoperative residual block. To date, no study has evaluated sugammadex performance after rocuronium administration in patients undergoing liver transplantation. This is a randomized controlled trial with the primary objective of assessing the neuromuscular transmission recovery time obtained with sugammadex versus neostigmine after rocuronium induced neuromuscular blockade in patients undergoing orthotopic liver transplantation. Methods The TOF-Watch SX®, calibrated and linked to a portable computer equipped with TOF-Watch SX Monitor Software®, was used to monitor and record intraoperative neuromuscular block maintained with a continuous infusion of rocuronium. Anaesthetic management was standardized as per our institution's internal protocol. At the end of surgery, neuromuscular moderate block reversal was obtained by administration of 2 mg/kg of sugammadex or 50 mcg/kg of neostigmine (plus 10 mcg/kg of atropine). Results Data from 41 patients undergoing liver transplantation were analysed. In this population, recovery from neuromuscular block was faster following sugammadex administration than neostigmine administration, with mean times±SD of 9.4±4.6 min and 34.6±24.9 min, respectively (p<0.0001). Conclusion Sugammadex is able to reverse neuromuscular block maintained by rocuronium continuous infusion in patients undergoing liver transplantation. The mean reversal time obtained with sugammadex was significantly faster than that for neostigmine. It is important to note that the sugammadex recovery time in this population was found to be considerably longer than in other surgical settings, and should be considered in clinical practice. Trial registration: ClinicalTrials.gov NCT02697929. Keywords: rocuronium, neostigmine, reversal, recovery time, liver transplantation.

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SUGAMMADEX ALWAYS FAST? PROBABLY YES, BUT IN LIVER TRANSPLANTATION

10.21203/rs.2.11130/v1 ◽

2019 ◽

Author(s):

CRISTIAN DEANA ◽

Federico Barbariol ◽

Stefano D’Incà’ ◽

Livia Pompei ◽

Giorgio Della Rocca

Keyword(s):

Liver Transplantation ◽

Continuous Infusion ◽

Recovery Time ◽

Neuromuscular Block ◽

Controlled Trial ◽

Anaesthetic Management ◽

Mean Value ◽

Primary Objective ◽

Randomized Controlled ◽

And Performance

Abstract Background: Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid postoperative residual. To date, no study has evaluated sugammadex use and performance after rocuronium administration in patients undergoing liver transplantation. This is a randomized controlled trial with the primary objective of assessing the recovery time of neuromuscular transmission with sugammadex versus neostigmine after rocuronium administration in patients undergoing LTx. Methods The TOF-Watch SX® with calibration and linked to a portable computer with TOF-Watch SX Monitor Software® was used to monitor and record intraoperative neuromuscular block, maintained with a continuous infusion of rocuronium. Anaesthetic management was standardized as per our institution's internal protocol. At the end of surgery, neuromuscular moderate block reversal was obtained after administration of 2 mg/kg of sugammadex or 50 mcg/kg of neostigmine (plus 10 mcg/kg of atropine). Results: Data from 41 patients undergoing liver transplantation were analysed. In this population, neuromuscular block recovery time was faster after administration of sugammadex than neostigmine, with a mean value±SD of 9.4±4.6 min vs. 34.6±24.9 min respectively (p<0.0001).Conclusion: neuromuscular block reversal after rocuronium continuous infusion was significantly faster with sugammadex than neostigmine and feasible in patients undergoing liver transplantation. It is important to note that sugammadex recovery time in this population was found to be considerably longer than in other surgical settings, an interesting finding that needs further studies to be fully explained and it should be taken into consideration in clinical practice.Trial registration: ClinicalTrials.gov NCT02697929.Keywords: rocuronium, neostigmine, reversal, recovery time, liver transplantation.

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SWOG S0715: Randomized placebo-controlled trial of acetyl-L-carnitine for the prevention of taxane-induced neuropathy during adjuvant breast cancer therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9018 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9018-9018 ◽

Cited By ~ 2

Author(s):

Dawn L. Hershman ◽

Joseph M Unger ◽

Katherine D. Crew ◽

Carol Moinpour ◽

Lori M. Minasian ◽

...

Keyword(s):

Breast Cancer ◽

Positive Impact ◽

Controlled Trial ◽

Performance Status ◽

Primary Objective ◽

Phase Iii ◽

Unexpected Finding ◽

Double Blind ◽

Phase Ii Studies ◽

The Mean

9018 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, disabling side effect of taxanes that leads to suboptimal treatment and diminished quality of life. Acetyl-L-Carnitine (ALC) is a natural compound involved in tubulin acetylation and neuronal protection. Pre-clinical and phase II studies suggest ALC may be effective for the prevention and treatment of CIPN. Methods: A randomized, double-blind, multi-center, phase III trial comparing ALC (1000 mg TID) vs placebo for 24 wks in women with stage I-III breast cancer undergoing adjuvant taxane therapy was conducted. The primary objective was to determine if ALC prevents CIPN as measured by the 11-item neurotoxicity (NTX) component of the FACT-Taxane scale (low score = worse NTX) at 12 wks. Secondary objectives included change at 24 wks, change in the Trial Outcome Index (TOI), fatigue (FACIT Fatigue) and NTX grade. Patients were stratified by planned treatment, and age (<60, ≥60). Results: 409 patients were evaluable (208 ALC, 201 placebo). No imbalances were observed by age, ethnicity, race, planned taxane treatment, performance status, or stage. The mean FACT-NTX score was 5.2 points lower at 12 wks on ALC and 4.5 points lower on placebo. In a linear regression adjusting for baseline score, planned treatment and age, wk 12 scores were 0.9 points lower on ALC than placebo (95% CI: -2.2 to 0.4, p=.17). At 24 wks, the mean observed FACT-NTX score was lower for ALC (5.3 vs. 3.6). In the multivariate model, wk 24 scores were 1.8 points lower on ALC (95% CI: -3.2 to -0.4, p=.01), representing more self-reported NTX. Grade 3/4 NTX was more frequent in the ALC arm (p=.04). Also at 24 wks, 38% on ALC had >5 point decrease score compared to 28% on placebo (OR=1.57, p=.05), and FACT-TOI scores were 3.5 points lower on ALC (95% CI: -6.5 to -0.4, p=.03). No differences between arms were observed for the FACIT-Fatigue scale or for other toxicities. Conclusions: There is no evidence that ALC has a positive impact on CIPN at 12 wks. However, ALC increases CIPN by 24 wks. Correlative studies are ongoing to explain this unexpected finding. Patients should be discouraged from using ALC and other supplements without proven efficacy.

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Systematic review on rocuronium continuous infusion for deep neuromuscular blockade

Current Clinical Pharmacology ◽

10.2174/1574884714666191120144331 ◽

2019 ◽

Vol 14 ◽

Author(s):

Mafalda Couto ◽

J. Guilherme Couto ◽

Catarina S. Nunes ◽

Sérgio Vide ◽

Pedro Amorim ◽

...

Keyword(s):

Continuous Infusion ◽

Deep Level ◽

Standard Dose ◽

Neuromuscular Block ◽

Muscle Relaxation ◽

Cochrane Library ◽

Reversal Agent ◽

Reversal Time ◽

Deep Neuromuscular Block ◽

Comprehensive Search

Background: Rocuronium is a muscle relaxant with increased use interest due to the binding relation with the reversal agent sugammadex. The purpose of this review entails the investigation of its use for the maintenance of deep neuromuscular block (NMB) via continuous infusion. Methods: Based on PRISMA systematic search guidelines, databases included PubMed, ISI Web of Science, Cochrane Library and google scholar. This comprehensive search addresses surgical patients under deep muscle relaxation via continuous rocuronium infusion. Main indicators were the rocuronium administration, NMB monitoring approaches and effects in order to maintain the deep level of relaxation, as well as reversal time after standard dose of sugammadex. Results: Despite the variance in approaches found in the literature, findings show the overall maintenance of deep NMB requires approximately 0.758 mg.kg-1h-1 of rocuronium (according to the PTC target of 0-10, 0-5 and 1-2, mean estimates are 0.445, 0.65 and 0.833 mg.kg-1h-1 respectively), suggesting that a lower range and smaller maximum of PTC response require higher amount of rocuronium for its maintenance. Standard dose of sugammadex (4 mg/kg), administered at the end of the surgery take longer [2.85 (1.17) min] than when administered after moderate NMB recovery [1.68 (0.47) min]. Conclusion: Continuous infusion for deep NMB presents inherent advantages in terms of maintenance and stability of the muscle relaxation. For that purpose, monitoring and rocuronium administration approaches are fundamental and intrinsically connected. Additional efforts should be placed in further studies to better understand the variability and methodological parameters for an improved maintenance of deep NMB.

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Conversion From Continuous Infusion Fentanyl to Continuous Infusion Hydromorphone in the Pediatric Intensive Care Unit

Annals of Pharmacotherapy ◽

10.1177/10600280211003170 ◽

2021 ◽

pp. 106002802110031

Author(s):

Maura Harkin ◽

Jamie L. Miller ◽

Sin Yin Lim ◽

Stephen B. Neely ◽

Christina K. Walsh ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Continuous Infusion ◽

Dose Reduction ◽

Mixed Models ◽

Pediatric Intensive Care ◽

Primary Objective ◽

Critically Ill Children ◽

The Mean

Background: Opioid rotations from fentanyl to hydromorphone may reduce opioid/sedative exposure in critically ill children. Objective: The primary objective was to determine the conversion percentage from fentanyl to hydromorphone infusions using equianalgesic conversions (0.1 mg fentanyl = 1.5 mg hydromorphone). Secondary objectives included identification of the median time and hydromorphone rate at stabilization (defined as the first 24-hour period no hydromorphone rates changed, 80% of State Behavioral Scale [SBS] scores between 0 and −1, and <3 hydromorphone boluses administered). Additional outcomes included a comparison of opioid/sedative requirements on the day of conversion versus the three 24-hour periods prior to conversion. Methods: This retrospective study included children <18 years old converted from fentanyl to hydromorphone infusions over 6.3 years. Linear mixed models were used to determine if the mean cumulative opioid/sedative dosing differed from the day of conversion versus three 24-hour periods prior to conversion. Results: A total of 36 children were converted to hydromorphone. The median conversion percentage of hydromorphone was 86% of their fentanyl dose (interquartile range [IQR] = 67-100). The median hydromorphone rate at stabilization was 0.08 mg/kg/h (IQR = 0.05-0.1). Eight (22%) were stabilized on their initial hydromorphone rate; 8 (22%) never achieved stabilization. Patients had a significant decrease in opioid dosing on the day of conversion versus the 24-hour period prior to conversion but no changes in sedative dosing following conversion. Conclusion and Relevance: A median 14% fentanyl dose reduction was noted when transitioning to hydromorphone. Further exploration is needed to determine if opioid rotations with hydromorphone can reduce opioid/sedative exposure.

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Which Strategy to Manage Severe Vaso-occlusive Crisis in Patients with Sickle Cell Disease in Countries with Limited Healthcare Capacities?

International Blood Research & Reviews ◽

10.9734/ibrr/2021/v12i230146 ◽

2021 ◽

pp. 7-13

Author(s):

Lydie Ocini Ngolet ◽

Chelsea Jayne Bango ◽

Peggy Mawandza ◽

Alexis Elira Dokekias

Keyword(s):

Pain Relief ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Controlled Trial ◽

Primary Objective ◽

Cell Disease ◽

Patient Controlled Analgesia ◽

Secondary Objective ◽

The Mean ◽

The Republic

We evaluated the treatment of morphine by intravenous patient controlled analgesia versus intermittent subcutaneous routes on patients with sickle cell disease developing severe vaso-occlusivecrisis. Objectives: The primary objective was to compare intravenous patient controlled analgesia (PCA) versus intermittent subcutaneous injection of morphine (SC) on sickle cell patients developing severe vaso-occlusive crisis during the first 24 hours of admission. The secondary objective was to assess the side effects of morphine in both regimens. Methods: A randomized controlled trial of 77 patients in the PCA and 81 in the SC group was conducted at the Sickle Cell Center of Brazzaville in the Republic of Congo. Participants aged from 15 to 45 years old with severe vaso-occlusive crisis were included in the study. Results: Both regimens provided pain relief. However, a significant pain reduction was observed 30 minutes after the administration of morphine in the PCA group (P= 0.001). The mean scores in the PCA and SC regimens were respectively: 1.16±1.40 and 4.30±2.32. The total median dose of morphine administered in the PCA regimen was markedly lower: 24,6±4,16 mg versus 36.6±3.1 mg in the SC group (P=0.01). Morphine administered by PCA provided pain relief during 24 hours while intermittent severe pain was experienced in the SC group (P=0.014). Sedation score S2, S3 was significantly observed in the SC group (P< 0.05).

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4 Saline-lock versus continuous infusion: maintaining peripheral intravenous catheter access in children

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.003 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e2-e2

Author(s):

Frances Yeung ◽

Sepideh Taheri ◽

Michael Miller ◽

Rahul Ojha ◽

Brianna McKelvie ◽

...

Keyword(s):

Continuous Infusion ◽

Pediatric Population ◽

Invasive Procedure ◽

Primary Objective ◽

Complication Rates ◽

Intravenous Catheter ◽

Chi Square ◽

Caregiver Satisfaction ◽

Peripheral Intravenous Catheter ◽

The Mean

Abstract Background Peripheral intravenous catheter (PIVC) insertion is a painful and invasive procedure performed on most paediatric patients. In children, PIVCs are maintained by either a continuous infusion of fluid “to keep vein open” (TKVO) or a saline-lock (SL). There is little uniformity between pediatric centres as to which method is used, and evidence is required to decide which method, if any, best maintains PIVC access. Objectives The primary objective was to compare duration of functional PIVC patency between TKVO and SL in children. Secondary objectives included assessing PIVC-related complications and patient/caregiver satisfaction. Design/Methods This prospective, time-allocated trial enrolled eligible patients from newborn to 17 years of age admitted to our pediatric ward. Patients enrolled in the first 3 months were assigned to TKVO, and patients in the latter 3 months were assigned to SL. Time of PIVC insertion and removal, PIVC-related complications, and satisfaction surveys were collected. Independent t-tests and chi-square tests were used to compare differences between arms for continuous and categorical outcomes, respectively. Results Complete PIVC data was available on 172 (n=85 TKVO, n=87 SL) of 194 enrolled patients. The mean (SD) duration of PIVC patency was 41.68 (41.71) hours in the TKVO group, and 44.05 (41.46) hours in the SL group, which was not statistically significant (p=0.71). There were no significant differences in complication rates or overall patient/caregiver satisfaction between the two groups. One patient in the TKVO group had their PIVC removed due to risk of strangulation from tubing. Conclusion There were no significant differences between TKVO and SL in the duration of PIVC patency in our pediatric population. This is consistent with previous results in neonates. There were also no significant differences in complication rates and overall patient/caregiver satisfaction. Overall, SL is a safe and reasonable alternative to TKVO in maintaining PIVC patency in children.

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Therapeutic Effects of Hab Shabyar on Open-Angle Glaucoma: A Double-Blinded, Randomized, Placebo-Controlled Trial

10.31661/gmj.v0i0.1218 ◽

2019 ◽

Vol 8 ◽

pp. 1218

Author(s):

Ebrahim Khalil BaniHabib ◽

Ali Mostafai ◽

Seyyed Mohammad Bagher Fazljou ◽

Ghadir Mohammdi

Keyword(s):

Placebo Group ◽

Intraocular Pressure ◽

Open Angle Glaucoma ◽

Controlled Trial ◽

Intervention Group ◽

Therapeutic Effects ◽

Open Angle ◽

The Mean ◽

The Right ◽

Double Blinded

Background: Open-angle glaucoma (OAG) is one of the leading causes of blindness worldwide. This study evaluates the therapeutic effects of hab shabyar in patients with open-angle glaucoma. Materials and Methods: In this clinical randomized controlled trial, 50 patients with OAG were randomized into two groups. The intervention group was received a drop of timolol plus 500 mg of hab shabyar every 12 hours. The placebo group was received a drop of timolol every 12 hours plus 500 mg of wheat germ as a placebo. The intraocular pressure in patients with OAG was measured in each group and compared at before the intervention (t1), one month (t2), and two months (t3) after the intervention. Results: The mean decrease in intraocular pressure for the right eye at three times in the intervention group was statistically significant, but the mean decrease in the placebo group was not significant. Similar results were obtained for the left eye at t1 when compared to t3. The patients in the intervention group expressed more satisfaction than the patients in the placebo group (P≤0.001). Conclusion: Our study demonstrated that consumption of timolol plus hab shabyar instead of consuming of timolol alone was probably more effective for reducing intraocular pressure in patients with OAG.[GMJ.2019;In press:e1218]

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