scholarly journals Effect of intravenous infusion of rocuronium on emergence from propofol anesthesia in rats

2020 ◽  
Author(s):  
Kaoru Suzuki ◽  
Hiroshi Sunaga ◽  
Kentaro Yamakawa ◽  
Yoshifumi Suga ◽  
Ichiro Kondo ◽  
...  
Keyword(s):  
Continuous Infusion ◽  
Neuromuscular Blockade ◽  
Normal Saline ◽  
Case Reports ◽  
Complete Recovery ◽  
Cerebrovascular Diseases ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Sprague Dawley ◽  
Blocking Agents

Abstract Background: Central nervous system effects of neuromuscular blocking agents have been indicated in some case reports. We investigated whether intravenous (IV) infusion of rocuronium affects emergence from propofol anesthesia in rats. Methods: We used Sprague Dawley rats. Propofol infusion was initiated with a bolus of 15 mg/kg and continued at a rate of 40 mg/kg/h. For the rocuronium group (n = 18), rocuronium was administered as an initial IV bolus of 5 mg/kg followed by continuous infusion at a rate of 250, 500, or 1000 μg/kg/min along with propofol infusion. Infusion was continued for 60 min, and sugammadex (32 mg/kg) was injected at the end of infusion. In a separate group of rats (n = 12), normal saline was administered along with propofol infusion. After continuous infusion for 60 min, normal saline or sugammadex (32 mg/kg) was injected. The time to emergence from propofol anesthesia was evaluated. To ascertain possible factors affecting emergence, the neuromuscular blocking, circulatory, and respiratory properties of IV rocuronium infusion at 1000 μg/kg/min were assessed (n = 18). Results: The time to emergence from propofol anesthesia was 239 ± 94 s after simultaneous infusion of normal saline without rocuronium and was 346 ± 78, 518 ± 134, and 638 ± 219 s after IV infusion of rocuronium at 250, 500, and 1000 μg/kg/min, respectively. The simultaneous IV infusion of rocuronium dose-dependently increased the time to emergence (ρ = 0.624; p = 0.006). Sugammadex alone did not delay emergence (280 ± 60 s; p = 0.39). Neuromuscular blockade induced by rocuronium at 1000 μg/kg/min was completely antagonized at 99 ± 21 s by sugammadex (32 mg/kg). Mean arterial pressure, heart rate, partial pressures of oxygen and carbon dioxide, and pH were not affected by rocuronium infusion. Conclusions: Our results show that IV infusion of rocuronium delays the emergence from propofol anesthesia in rats, despite the complete recovery from neuromuscular blockade by sugammadex. The use of neuromuscular blocking agents in neonates or patients with cerebrovascular diseases, whose blood-brain barrier might be immature or disrupted, should be carefully considered.

Sugammadex is changing the paradigm in neuromuscular blockade in patients with myotonic dystrophy

2019 ◽  
Vol 29 (10) ◽  
pp. 337-340 ◽  
Author(s):  
Joana Teixeira ◽  
Bernardo Matias ◽  
Irene Ferreira ◽  
Tiago Taleço ◽  
João S Duarte
Keyword(s):  
General Anaesthesia ◽  
Myotonic Dystrophy ◽  
Neuromuscular Blockade ◽  
Perioperative Complications ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Myotonic Dystrophy Type 1 ◽  
Myotonic Dystrophy Type ◽  
Blocking Agents

Myotonic dystrophy type 1 is a rare neuromuscular disease that represents a challenge to anaesthetic management. Most of the literature does not recommend the usage of neuromuscular blocking agents, if general anaesthesia is needed in these patients. Depolarising neuromuscular blocking agents like suxamethonium are contraindicated, and there might be an increased sensitivity to non-depolarising agents like rocuronium with greater risk of postoperative residual neuromuscular blockade and consequent respiratory failure. Reversing neuromuscular blockade is also problematic as neostigmine can induce myotonic crisis, impairing normal ventilation. We discuss the use of sugammadex for neuromuscular blockade reversal, from a clinical case of a patient with myotonic dystrophy type 1 for laparoscopic cholecystectomy. The patient had a general anaesthesia with neuromuscular blockade with rocuronium. After the surgical procedure, neuromuscular blockade was safely reversed with sugammadex, guided by neuromuscular monitoring without any perioperative complications.

Myopathy in Status Asthmaticus: Relation to Neuromuscular Blockade and Corticosteroid Administration

1993 ◽  
Vol 8 (3) ◽  
pp. 144-152 ◽  
Author(s):  
Janet M. Shapiro ◽  
Rany Condos ◽  
Randolph P. Cole
Keyword(s):  
Mechanical Ventilation ◽  
Creatine Kinase ◽  
Neuromuscular Blockade ◽  
Muscle Weakness ◽  
Status Asthmaticus ◽  
Rare Complication ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Corticosteroid Administration ◽  
Blocking Agents

Myopathy is a rare complication that arises during management of status asthmaticus that may be related to administration of corticosteroids and neuromuscular blocking agents. We present 4 patients with myopathy and a review of the 31 previously reported patients in the literature. All patients received corticosteroids, and 33 of the 35 patients received neuromuscular blocking agents. Muscle weakness was often diffuse and, in several patients, involved the muscles of respiration. Creatine kinase values ranged from normal to markedly elevated. Diagnosis was obtained by electromyogram and muscle biopsy in most patients. Resolution of the muscle weakness occurred over a period of days to months. Patients in whom myopathy developed required mechanical ventilation for longer periods than patients intubated for status asthmaticus without myopathy.

scholarly journals Intravenous infusion of rocuronium bromide prolongs emergence from propofol anesthesia in rats

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246858
Author(s):  
Kaoru Suzuki ◽  
Hiroshi Sunaga ◽  
Kentaro Yamakawa ◽  
Yoshifumi Suga ◽  
Ichiro Kondo ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Normal Saline ◽  
Intravenous Infusion ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Rocuronium Bromide ◽  
Blocking Agents ◽  
Sites Of Action

Background Neuromuscular blocking agents induce muscle paralysis via the prevention of synaptic transmission at the neuromuscular junction and may have additional effects at other sites of action. With regard to potential effects of neuromuscular blocking agents on the central nervous system, a definitive view has not been established. We investigated whether intravenous infusion of rocuronium bromide affects the emergence from propofol anesthesia. Methods Using an in vivo rat model, we performed propofol infusion for 60 minutes, along with rocuronium bromide at various infusion rates or normal saline. Sugammadex or normal saline was injected at the end of the infusion period, and we evaluated the time to emergence from propofol anesthesia. We also examined the neuromuscular blocking, circulatory, and respiratory properties of propofol infusion along with rocuronium bromide infusion to ascertain possible factors affecting emergence. Results Intravenous infusion of rocuronium bromide dose-dependently increased the time to emergence from propofol anesthesia. Sugammadex administered after propofol infusion not containing rocuronium bromide did not affect the time to emergence. Mean arterial pressure, heart rate, partial pressures of oxygen and carbon dioxide, and pH were not affected by rocuronium bromide infusion. Neuromuscular blockade induced by rocuronium bromide, even at the greatest infusion rate in the emergence experiment, was rapidly antagonized by sugammadex. Conclusions These results suggest that intravenous infusion of rocuronium bromide dose-dependently delays the emergence from propofol anesthesia in rats. Future studies, such as detection of rocuronium in the cerebrospinal fluid or central nervous system, electrophysiologic studies, microinjection of sugammadex into the brain, etc., are necessary to determine the mechanism of this effect.

Acute Myopathy Associated with Combined use of Corticosteroids and Neuromuscular Blocking Agents

1996 ◽  
Vol 30 (12) ◽  
pp. 1437-1445 ◽  
Author(s):  
Janet R Fischer ◽  
Rebecca K Baer
Keyword(s):  
English Language ◽  
Case Reports ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Mechanically Ventilated ◽  
Medline Search ◽  
Blocking Agents ◽  
Systemic Corticosteroids ◽  
Combined Use

OBJECTIVE: To review the occurrence and pathophysiology of myopathy associated with combined use of neuromuscular blocking agents (NMBAs) and systemic corticosteroids. DATA SOURCES: A MEDLINE search (1985 to July 1995, English language) yielded case reports and clinical studies involving myopathy or weakness associated with the use of NMBAs and/or corticosteroids. References cited in those articles were reviewed. DATA SYNTHESIS: Prolonged muscle weakness has been reported in intubated patients in the intensive care unit (ICU) who were receiving NMBAs and/or corticosteroids. Many cases involved the use of both agents in individuals with no underlying risk factors. The term “blocking agent—corticosteroid myopathy” (BACM) has been used to describe this myopathy when it develops following combined use of these agents. Features common to BACM include prolonged weakness, elevated creatine kinase concentrations, myopathic features on electromyography, normal nerve conduction and sensation, and reduced deep tendon reflexes. Muscle biopsy results vary, but tend to show type 1 and/or 2 fiber atrophy without inflammation. Some recently reported cases revealed thick myosin myofilament loss, which is consistent with findings in denervated rat muscle after exposure to corticosteroids. Two small prospective studies reported that 36–50% of mechanically ventilated patients receiving either one or both drugs developed prolonged weakness. CONCLUSIONS: NMBAs and corticosteroids alone have both been reported to cause myopathy in patients in the ICU. When coadministered, these agents appear to confer an even greater risk of myopathy; the exact pathology is not understood. Concomitant use of NMBAs and corticosteroids should be avoided if possible. Guidelines for cautious use and careful monitoring are suggested when combined use is deemed necessary.

scholarly journals Residual Neuromuscular Blockade Affects Postoperative Pulmonary Function

2012 ◽  
Vol 117 (6) ◽  
pp. 1234-1244 ◽  
Author(s):  
Gopalaiah Venkatesh Kumar ◽  
Anita Pramod Nair ◽  
Hanuman Srinivasa Murthy ◽  
Koppa Ramegowda Jalaja ◽  
Karnate Ramachandra ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Peak Expiratory Flow ◽  
Postoperative Period ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Blocking Agents ◽  
Train Of Four ◽  
Expiratory Flow

Abstract Background Residual neuromuscular blockade (RNMB) is known to be associated with respiratory complications in the postoperative period after muscle relaxant usage. The authors hypothesized that RNMB causes reductions in pulmonary function test (PFT) parameters in the immediate postoperative period. Methods An open-label prospective randomized cohort study was conducted comparing reductions in PFT parameters due to RNMB among different neuromuscular blocking agents. One hundred and fifty patients were randomized to receive vecuronium, atracurium, or rocuronium. After reversal of neuromuscular blockade and extubation, train-of-four ratio was measured every 5 min until the train-of-four ratio of 0.9 or greater was attained. PFTs were performed preoperatively and postoperatively when the patients were willing and fit. The train-of-four ratio, measured at PFT, was used to classify patients into “RNMB absent” and “RNMB present.” RNMB was defined as a train-of-four ratio less than 0.9. Results Thirty-nine patients had RNMB at the time of performing PFT. There was no statistically significant difference in the postoperative reductions in PFT parameters in patients with RNMB among different neuromuscular blocking agents. Patients were regrouped as RNMB absent and RNMB present, irrespective of neuromuscular blocking agents. Postoperative PFT values for the RNMB-absent and RNMB-present groups were 62% and 49% of baseline forced vital capacity and 47% and 38% of baseline peak expiratory flow of the baseline, respectively. Postoperative forced vital capacity and peak expiratory flow values of RNMB-present patients were lower by 13% and 9% in absolute terms (P < 0.008) and 21% and 19% in relative terms, respectively, compared with RNMB-absent patients. Conclusion RNMB results in reductions in forced vital capacity and peak expiratory flow in the immediate postoperative period indicating impaired respiratory muscle function.

scholarly journals Sugammadex: A neuromuscular blockade agent encapsulator

2017 ◽  
Vol 5 (20) ◽  
pp. 44 ◽  
Author(s):  
Victoria Yepes Hurtado
Keyword(s):  
Neuromuscular Blockade ◽  
Current Literature ◽  
Neuromuscular Blocking ◽  
Muscle Relaxants ◽  
Neuromuscular Blocking Agents ◽  
New Class ◽  
Blocking Agents

Sugammadex sodium, a modified γ-cyclodextrin, represents a new class of drugs effectiveat reversing non-depolarizing muscle relaxants rocuronium and vecuronium. The cylindrical,basket-like structure encapsulates neuromuscular blocking agents which results in rapidreversal of paralysis within three minutes. The current literature was reviewed to analyze theclinical implications and considerations with its administration.

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