Magnesium sulfate decreases the dose of rocuronium for satisfactory double lumen tube placement condition in patients with myasthenia gravis

Abstract Background: Titrating a low dose of non-depolarizing neuromuscular blockers for induction of general anesthesia for patients with myasthenia gravis (MG) is a popular accepted practice. This practice may confront with unsatisfactory intubation conditions, especially for double lumen tube (DLT). This double-blind randomised study was to investigate whether magnesium sulfate could decrease the rocuronium demand and improve the DLT placement conditions for MG patients who scheduled for video-assisted thoracoscopic (VATS) thymectomy. Methods: The patients were randomly assigned into the magnesium sulfate or normal saline group. After acquiring the adequate sedative depth, magnesium sulfate(60mg.kg-1) or normal saline(control) was given to the patients in two groups respectively. After that, the same Train of Four (TOF) value was obtained with one or more doses of 0.05 mg.kg-1 rocuronium with 3 minutes interval, then DLT was intubated. The primary and secondary observational outcomes were the cumulative rocuronium dose and the intubation condition for DLT placement respectively. Results: 23 patients in the magnesium sulphate group and 22 patients in the control group completed the study. The amount of rocuronium used to meet the setting value of TOF were 0.10 (0.05)mg.kg-1 and 0.28(0.17) mg.kg-1 in the magnesium sulphate and control group respectively (P<0.0001). Under a similar depth of neuromuscular blockade and sedation, 23 patients in magnesium sulphate group and 16 patients in control group showed excellent intubation condition. The patients in both groups showed similar characteristics of recovery from neuromuscular blockade. Conclusions: Our research showed that magnesium sulfate could decrease the rocuronium demand for satisfactory DLT intubation condition in MG patients.

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Magnesium sulfate decreases the dose of rocuronium for satisfactory double lumen tube placement condition in patients with myasthenia gravis

10.21203/rs.2.414/v2 ◽

2019 ◽

Author(s):

Shoujun Fei ◽

Hengfu Xia ◽

Xiaowei Chen ◽

Dazhi Pang ◽

Xuebing Xu

Keyword(s):

Myasthenia Gravis ◽

Magnesium Sulfate ◽

Normal Saline ◽

Magnesium Sulphate ◽

Double Lumen Tube ◽

Control Group ◽

Sulphate Group ◽

Double Lumen ◽

Lumen Tube ◽

Intubation Condition

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Magnesium sulfate reduces the rocuronium dose needed for satisfactory double lumen tube placement conditions in patients with myasthenia gravis

10.21203/rs.2.414/v5 ◽

2019 ◽

Author(s):

Shoujun Fei ◽

Hengfu Xia ◽

Xiaowei Chen ◽

Dazhi Pang ◽

Xuebing Xu

Keyword(s):

Myasthenia Gravis ◽

Magnesium Sulfate ◽

Neuromuscular Blockade ◽

Normal Saline ◽

Double Lumen Tube ◽

Tube Placement ◽

Double Lumen ◽

Lumen Tube ◽

Vats Thymectomy ◽

Intubation Condition

Abstract Background: Using a minimum dose of neuromuscular blockade (NMB) to achieve intubation condition is one of the goals in anaesthesia management of patients with myasthenia gravis (MG) for thoracoscopic (VATS) thymectomy. However, tracheal intubation with double lumen tube (DLT) could be challenging if intubation condition is not optimal. This double-blind randomised controlled study was designed to investigate whether magnesium sulfate would reduce the rocuronium dose needed for DLT intubation and improve the DLT placement condition for patients with MG who were scheduled for video-assisted thoracoscopic (VATS) thymectomy. Methods: Recruited patients were randomly assigned to receive magnesium sulfate 60mg.kg -1 or normal saline (control) prior to the administration of NMB. Titrating dose of rocuronium was administered to achieve train of four (TOF) ratio less than 10% before DLT intubation. The primary outcome was the rocuronium dose required to achieve TOF ratio less than 10%. The secondary outcome was intubation condition for DLT placement. Results: Twenty-three patients had received magnesium sulfate and 22 patients had received normal saline before rocuronium administration. The required rocuronium dose[mean (standard deviation)] were 0.10 (0.05) mg.kg -1 and 0.28(0.17) mg.kg -1 in patients who had magnesium sulfate and normal saline respectively( P <0.0001). With a similar depth of neuromuscular blockade and depth of anaesthesia, 100% of patients in the magnesium sulfate group and 72.7% of patients in the control group showed excellent intubation condition ( P = 0.027) respectively. The patients in both groups had similar emergence characteristics. Conclusions: Magnesium sulfate is associated with a decrease in rocuronium requirement for an optimal DLT intubation condition in patients with MG for VATS thymectomy. Trial registration: Clinical Trial Registry of China (http://www.chictr.org.cn ) identifier：ChiCTR-1800017696, retrospectively registered on August 10, 2018. Key words : Magnesium sulfate; double lumen tube; myasthenia gravis; intubation; rocuronium

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Magnesium sulfate reduces the rocuronium dose needed for satisfactory double lumen tube placement conditions in patients with myasthenia gravis

10.21203/rs.2.414/v4 ◽

2019 ◽

Author(s):

Shoujun Fei ◽

Hengfu Xia ◽

Xiaowei Chen ◽

Dazhi Pang ◽

Xuebing Xu

Keyword(s):

Myasthenia Gravis ◽

Magnesium Sulfate ◽

Neuromuscular Blockade ◽

Normal Saline ◽

Double Lumen Tube ◽

Tube Placement ◽

Double Lumen ◽

Lumen Tube ◽

Vats Thymectomy ◽

Intubation Condition

Abstract Background: Using a minimum dose of neuromuscular blockade (NMB) to achieve intubation condition is one of the goals in anaesthesia management of patients with myasthenia gravis (MG) for thoracoscopic (VATS) thymectomy. However, tracheal intubation with double lumen tube (DLT) could be challenging if intubation condition is not optimal. This double-blind randomised controlled study was designed to investigate whether magnesium sulfate would reduce the rocuronium dose needed for DLT intubation and improve the DLT placement condition for patients with MG who were scheduled for video-assisted thoracoscopic (VATS) thymectomy. Methods: Recruited patients were randomly assigned to receive magnesium sulfate 60mg.kg-1 or normal saline (control) prior to the administration of NMB. Titrating dose of rocuronium was administered to achieve train of four (TOF) ratio less than 10% before DLT intubation. The primary outcome was the rocuronium dose required to achieve TOF ratio less than 10%. The secondary outcome was intubation condition for DLT placement. Results: Twenty-three patients had received magnesium sulfate and 22 patients had received normal saline before rocuronium administration. The required rocuronium dose[mean (standard deviation)] were 0.10 (0.05) mg.kg-1 and 0.28(0.17) mg.kg-1 in patients who had magnesium sulfate and normal saline respectively(P<0.0001). With a similar depth of neuromuscular blockade and depth of anaesthesia, 100% of patients in the magnesium sulfate group and 72.7% of patients in the control group showed excellent intubation condition (P = 0.027) respectively. The patients in both groups had similar emergence characteristics. Conclusions: Magnesium sulfate is associated with a decrease in rocuronium requirement for an optimal DLT intubation condition in patients with MG for VATS thymectomy.

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Magnesium sulfate reduces rocuronium dose needed for satisfactory double lumen tube placement condition in patients with myasthenia gravis

10.21203/rs.2.414/v3 ◽

2019 ◽

Author(s):

Shoujun Fei ◽

Hengfu Xia ◽

Xiaowei Chen ◽

Dazhi Pang ◽

Xuebing Xu

Keyword(s):

Magnesium Sulfate ◽

Neuromuscular Blockade ◽

Normal Saline ◽

Magnesium Sulphate ◽

Double Lumen Tube ◽

Tube Placement ◽

Secondary Outcome ◽

Double Lumen ◽

Lumen Tube ◽

Intubation Condition

Abstract Background: Using minimum dose of neuromuscular blockade (NMB) to achieve intubation condition is the goal in management of patients with myathenia gravis (MG). However, tracheal intubation with double lumen tube (DLT) can be challenging if intubation condition is not optimal. This double-blind randomised controlled study was designed to investigate whether magnesium sulfate would reduce rocuronium dose needed and improve the DLT placement conditions for patients with MG who were scheduled for video-assisted thoracoscopic (VATS) thymectomy. Methods: Recruited patients were randomly assigned to receive magnesium sulfate 60mg.kg-1 or normal saline (control) prior to the administration of NMB. Titrating dose of rocuronium was administered to achieve train of four ratio (TOF%) to 10% or below before DLT intubation. The primary outcome was the rocuronium dose required to achieve TOF% below 10%. Secondary outcome was intubation condition for DLT placement. Results: Twenty-three patients had magnesium sulphate and 22 patients had normal saline before rocuronium administration. The required rocuronium dose used were 0.10 (0.05) mg.kg-1 and 0.28(0.17) mg.kg-1 in patients who had magnesium sulphate and normal saline respectively (P<0.0001). With a similar depth of neuromuscular blockade and depth of anaesthesia, 23 patients in the magnesium sulphate group and 16 patients in the control group had excellent intubation condition (P = 0.027). The patients in both groups had similar emergence characteristics. Conclusions: Magnesium sulfate is associated with a decrease in the rocuronium requirement and better DLT intubation condition in patients with MG.

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Magnesium sulfate reduces the rocuronium dose needed for satisfactory double lumen tube placement conditions in patients with myasthenia gravis

BMC Anesthesiology ◽

10.1186/s12871-019-0841-4 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Shoujun Fei ◽

Hengfu Xia ◽

Xiaowei Chen ◽

Dazhi Pang ◽

Xuebing Xu

Keyword(s):

Myasthenia Gravis ◽

Magnesium Sulfate ◽

Double Lumen Tube ◽

Tube Placement ◽

Double Lumen ◽

Lumen Tube

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The combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomized controlled trial

10.21203/rs.3.rs-112957/v1 ◽

2020 ◽

Author(s):

Yongheng Hou ◽

Huayue Liu ◽

Wencheng Shi ◽

Hengjing Zhao ◽

Ke Peng ◽

...

Keyword(s):

Computed Tomography ◽

Main Bronchus ◽

Controlled Trial ◽

Fiberoptic Bronchoscopy ◽

Double Lumen Tube ◽

Control Group ◽

Trial Registry ◽

Double Lumen ◽

Lumen Tube ◽

The Right

Abstract Background: Accurate placement of the right-sided double-lumen tube (RDLT) is still challenging. This study aims to explore the feasibility and accuracy of a modified intubation strategy by using a combination of computed tomography measurements and flexible video bronchoscope guidance.Methods: 108 adults requiring an RDLT for lung isolation were randomly allocated to 2 groups. Conventional fiberoptic bronchoscopy-guided technique was used in the control group. The following specifications applied to the modification group. Firstly, the length of the right main bronchus (RMB-L) and the anteroposterior diameter of RMB were measured in preoperative spiral computed tomography to predict the side and size of the tube; Then, a depth marker was made on RUSCH tube according to the difference between the RMB-L and the length of bronchia cuff (12 mm); Under the guidance of flexible video bronchoscope, the depth marker should be paralleled with the tracheal carina, and a characteristic white line on the tube should be paralleled with the secondary carina.Results: Compared with the control group, our modified strategy significantly increased the optimal plus acceptable position rate (76% vs. 98%, respectively; P < 0.039), decreased tube replacement rate (80% vs. 94%; P = 0.042), shortened the intubation time (101.4 ± 7.3 vs. 75.2 ± 8.1 seconds; P = 0.019), and had a lower incidence of transient hypoxemia (25% vs. 6%; P = 0.022), subglottic resistance (20% vs. 6%; P = 0.037), tracheobronchial injury (35% vs. 13; P = 0.037), and postoperative right upper lobe collapse (15% vs. 2%; P = 0.059).Conclusion: These data suggest the superiority of our modified technique compared to the conventional method for RDLT positioning.Trial registration: Chinese Clinical Trial Registry, ChiCTR1900021676, registered on 5 March 2019. URL of trial registry: http://www.chictr.org.cn/showprojen.aspx?proj=33189

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