scholarly journals Comparison of Neuromuscular Blockade Recovery Co-Administered With Neostigmine and Different Doses of Calcium Gluconate: A Randomized Control Trial

2020 ◽  
Author(s):  
So Ron Choi ◽  
Sang Yoong Park ◽  
Jeong Ho Kim ◽  
Kyung Hyun Lee
Keyword(s):  
Neuromuscular Blockade ◽  
Calcium Gluconate ◽  
Transmitter Release ◽  
Recovery Time ◽  
Statistical Significance ◽  
Acetylcholinesterase Inhibitors ◽  
Control Group ◽  
Dependent Relationship ◽  
Train Of Four ◽  
Residual Curarization

Abstract Background: Calcium increases the probability of transmitter release at the neuromuscular junction. However, it is not known whether there is a dose-dependent relationship between the dosage of calcium gluconate and the probability of transmitter release for non-depolarizing neuromuscular blockade (NMB) recovery by acetylcholinesterase inhibitors (AchEIs). This study compared the neuromuscular recovery time and the incidence of postoperative residual curarization (PORC) according to the dosage of calcium gluconate co-administered with neostigmine in three patient groups.Methods: Patients were randomly allocated to a control group, a 5 mg/kg calcium gluconate group (calcium 5 group), or a 10 mg/kg calcium gluconate group (calcium 10 group). The primary endpoint was neuromuscular recovery time. The secondary endpoints were the incidence of PORC at 5, 10, and 20 minutes after reversal administration and the train-of-four ratio (TOFr) at each time point.Results: The neuromuscular recovery time was 5.3 minutes in the control group, 3.9 minutes in the calcium 5 group, and 4.1 minutes in the calcium 10 group, respectively (P=0.012). Neuromuscular recovery time was significantly different between the control and calcium 10 groups (P=0.017). The incidence of PORC at 5 minutes after neostigmine administration was 12 (46.2%) in the control group, 4 (15.4%) in the calcium 5 group, and 4 (15.4%) in the calcium 10 group, respectively, with statistical significance (P=0.014). Conclusions: The co-administration of 10 mg/kg calcium gluconate with neostigmine achieved early NMB recovery and had the fewest variables.Trial Registration: https://cris.nih.go.kr/cris/index.jsp(KCT0004182). Date of registration:12 august 2019.

scholarly journals Comparison of neuromuscular blockade recovery co-administered with neostigmine and different doses of calcium gluconate: a randomized control trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
So Ron Choi ◽  
Jeong Ho Kim ◽  
Kyung Hyun Lee ◽  
Sang Yoong Park
Keyword(s):  
Neuromuscular Blockade ◽  
Calcium Gluconate ◽  
Transmitter Release ◽  
Recovery Time ◽  
Statistical Significance ◽  
Acetylcholinesterase Inhibitors ◽  
Control Group ◽  
Dependent Relationship ◽  
Train Of Four ◽  
Residual Curarization

Abstract Background Calcium increases the probability of transmitter release at the neuromuscular junction. It is not known whether there is a dose-dependent relationship between the dosage of calcium gluconate and the probability of transmitter release for non-depolarizing neuromuscular blockade (NMB) recovery by acetylcholinesterase inhibitors (AchEIs). This study compared the neuromuscular recovery time and the incidence of postoperative residual curarization (PORC) according to the dosage of calcium gluconate co-administered with neostigmine in three patient groups. Methods Patients were randomly allocated to a control group, a 5 mg/kg calcium gluconate group (calcium 5 group), or a 10 mg/kg calcium gluconate group (calcium 10 group). In patients with a TOF ratio (TOFr) between 0.2–0.7, 0.04 mg/kg of neostigmine was administered and both 0.2 mg of glycopyrrolate and 0.4 mg of atropine per 1 mg of neostigmine were administered. And additional 5 or 10 mg/kg of calcium gluconate were administrated to the calcium 5 and 10 groups. The primary endpoint was neuromuscular recovery time (the time between reversal and TOFr≥0.9). The secondary endpoints were the incidence of PORC at 5, 10, and 20 min after reversal administration and the train-of-four ratio (TOFr) at each time point. Results The neuromuscular recovery time was 5.3 min in the control group, 3.9 min in the calcium 5 group, and 4.1 min in the calcium 10 group, respectively (P = 0.004). The incidence of PORC at 5 min after neostigmine administration was 12 in the control group, 4 in the calcium 5 group, and 4 in the calcium 10 group, respectively, with statistical significance (P = 0.014). Conclusions The co-administration of calcium gluconate with neostigmine safely promoted early NMB recovery, and the neuromuscular recovery time of the calcium 10 group tended to be more evenly distributed than that of the calcium 5 group. Trial registration https://cris.nih.go.kr/cris/index.jsp(KCT0004182). Date of registration: August 122,019.

scholarly journals Effect of Chronic Exposure to Dexamethasone on Rocuronium-induced Neuromuscular Blockade and Sugammadex Reversal: an in Vivo Study on Rats

2021 ◽  
Author(s):  
Ha Yeon Park ◽  
Heyran Choi ◽  
Yong Beom Kim ◽  
Seok Kyeong Oh ◽  
Taehoon Kim ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Chronic Exposure ◽  
Recovery Time ◽  
Medical Center ◽  
Control Group ◽  
Sprague Dawley ◽  
Dexamethasone Group ◽  
Sprague Dawley Rats ◽  
Train Of Four

Abstract Background: Chronic exposure to glucocorticoids is associated with resistance to nondepolarising neuromuscular blocking agents. Therefore, we hypothesised that sugammadex-induced recovery in subjects with chronic exposure to dexamethasone was faster than that in subjects without dexamethasone exposure. Objective: To evaluate the recovery profile of rocuronium-induced neuromuscular blockade after sugammadex administration in rats. Design: An in vivo study on rats.Setting: Asan Institute for Life Sciences, Asan Medical Center, Korea, from April 2017 to October 2017.Animals: Thirty-six male Sprague-Dawley rats.Intervention: Sprague–Dawley rats were allocated to three groups (dexamethasone group, control group, and pair-fed group) for the in vivo study. Dexamethasone group received daily intraperitoneal injections of dexamethasone 500 μg kg-1 or 0.9% saline for 15 days. On the sixteenth day, 3.5 mg kg-1 of rocuronium was administered to achieve complete neuromuscular blockade. Main outcome measures: The recovery time to a train-of-four ratio Results: There were no significant differences in the recovery time to train-of-four ratio to 0.9 among the groups (P = 0.531). The time to second twitch of train-of-four recovery that indicated the duration of rocuronium-induced neuromuscular blockade was significantly shorter in Group D than in Groups C and P (P = 0.001). Conclusion: As previously reported, resistance to rocuronium was observed in rats with chronic exposure to dexamethasone. However, the neuromuscular recovery time after sugammadex administration was not significantly different between groups.

scholarly journals Reversal of Deep Effect of Rocuronium by Sugammadex or Neostigmine after Abdominal Laparoscopic Surgery: A Single Center Experience in Vietnam

2020 ◽  
Vol 8 (B) ◽  
pp. 295-300
Author(s):  
Le Van Dong ◽  
Nguyen Truong Giang ◽  
Nguyen Manh Cuong ◽  
Ngo Van Dinh ◽  
Vu The Anh ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Neuromuscular Blockade ◽  
Statistical Significance ◽  
Comparative Trial ◽  
Military Hospital ◽  
Concurrent Administration ◽  
Single Center Experience ◽  
Train Of Four ◽  
Residual Curarization ◽  
Neuromuscular Blockade Reversal

BACKGROUND: Using sugammadex allows to quickly reverse deep neuromuscular blockade with rocuronium in laparoscopic surgery, which results in great benefits during and after surgery by minimizing the problem of postoperative residual curarization. AIM: The aims of this study are comparing the efficacy of reversing neuromuscular blockade between sugammadex and neostigmine and evaluating its unwanted effects after laparoscopic abdominal surgery. METHODS: Subject of this prospective clinical comparative trial was patients who underwent abdominal laparoscopic surgery at 103 Military Hospital from October 2017 to October 2018. Eighty-four patients suffering from abdominal laparoscopic surgery under deep neuromuscular blockade were enrolled and divided randomly into two groups with 42 patients in each: Group N used neostigmine for neuromuscular blockade reversal and Group S applied sugammadex. At the end of surgery, neuromuscular blockade was reversed with either sugammadex or neostigmine. RESULTS: The reversal time to achieve train-of-four ratio >0.9 in the sugammadex group was 2.42 ± 0.58 min, which was shorter than in the neostigmine group (11.83 ± 2.19 min) (p < 0.05). The time until extubation in the sugammadex group was 3.69 ± 0.67 min, which was shorter than in the neostigmine group 11.90 ± 2.22 min (p < 0.05). Reversal with sugammadex resulted in statistical significance of less sputum production (0% vs. 11.9%), dry mouth (0% vs. 28.57%), headache (2.38% vs. 7.14%), and nausea (4.76% vs. 14.28%) compared with neostigmine. However, 26.19% of patients in the neostigmine group presented bradycardia, whereas the concurrent administration of atropine in the neostigmine group resulted in increased heart rate. CONCLUSION: Sugammadex reversed neuromuscular blockade more rapidly and effectively than neostigmine in abdominal laparoscopic surgeries. The unwanted effects of sugammadex group were fewer than neostigmine group.

Does Train-of-Four Monitoring Reduce Recovery Time After Neuromuscular Blockade?

1998 ◽  
Vol 26 (11) ◽  
pp. 1920
Author(s):  
Edward L. Peterson ◽  
Barbara J. Zarowitz ◽  
Maria L. Rudis
Keyword(s):  
Neuromuscular Blockade ◽  
Recovery Time ◽  
Train Of Four ◽  
Train Of Four Monitoring

scholarly journals Reversal of Meeting Abstracts by Sugammadex after Continuous Infusion of Rocuronium in Patients Randomized to Sevoflurane or Propofol Maintenance Anesthesia

2009 ◽  
Vol 111 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Christopher Rex ◽  
Stefanie Wagner ◽  
Claudia Spies ◽  
Jens Scholz ◽  
Henk Rietbergen ◽  
...  
Keyword(s):  
Single Dose ◽  
Continuous Infusion ◽  
Neuromuscular Blockade ◽  
Recovery Time ◽  
Clinical Effect ◽  
Parallel Group ◽  
Median Plasma ◽  
Train Of Four ◽  
American Society ◽  
Posttetanic Count

Background Sugammadex rapidly reverses neuromuscular blockade induced by bolus rocuronium doses, but it has not been investigated after continuous rocuronium infusion in surgical patients. We therefore examined the clinical effect of sugammadex for neuromuscular blockade induced by continuous rocuronium infusion in adults undergoing surgery under maintenance anesthesia with sevoflurane or propofol. Methods This four-center, comparative, parallel-group study, randomly assigned 52 adult patients (American Society of Anesthesiologists Class I-III) to maintenance anesthesia with sevoflurane or propofol. Neuromuscular blockade was induced by bolus injection of 0.6 mg/kg rocuronium followed by continuous infusion of 7 microg x kg(-1) x min(-1) rocuronium adjusted to maintain a neuromuscular blockade depth of zero response to train-of-four and a posttetanic count of no more than 10 responses. A single dose of 4 mg/kg sugammadex was administered at first twitch (T1) 3-10%. The primary clinical effect variable was recovery time to a train-of-four ratio of 0.9. Results Median recovery time from start of sugammadex administration to a train-of-four ratio of 0.9 in the sevoflurane and propofol groups was 1.3 and 1.2 min, respectively. The estimated difference in recovery time between groups was 9 s (95% confidence interval -6 to 20 s), entirely within the predefined equivalence interval. Median plasma rocuronium concentration just before sugammadex administration was 33% lower during maintenance anesthesia with sevoflurane than with propofol. Sugammadex was well tolerated. One adverse event (procedural hypotension) was considered to be probably related to sugammadex. Conclusions Single-dose sugammadex (4 mg/kg) after continuous rocuronium infusion is equally effective and well tolerated during maintenance anesthesia with sevoflurane or propofol.

scholarly journals Effects of hydrogen peroxide on diazepam and xylazine sedation in chicks

2012 ◽  
Vol 5 (4) ◽  
pp. 179-183 ◽  
Author(s):  
Yaareb J. Mousa ◽  
Fouad K. Mohammad
Keyword(s):  
Oxidative Stress ◽  
Hydrogen Peroxide ◽  
Recovery Time ◽  
Tap Water ◽  
Statistical Significance ◽  
Control Group ◽  
Dependent Manner ◽  
Water Control ◽  
Whole Brain ◽  
Total Recovery

ABSTRACT Oxidative stress may cause various neuronal dysfunctions and modulate responses to many centrally acting drugs. This study examines the effects of oxidative stress produced by hydrogen peroxide (H2O2) on sedation induced by diazepam or xylazine as assessed in 7-14 day-old chicks. Day-old chicks were provided with either plane tap water (control group) or H2O2 in tap water as 0.5% v/v drinking solution for two weeks in order to produce oxidative stress. Spectrophotometric methods were used to determine glutathione and malondialdehyde concentrations in plasma and whole brain. Drug-induced sedation in the chicks was assessed by monitoring the occurrence of signs of sedation manifested as drooping of the head, closed eyelids, reduced motility or immotility, decreased distress calls, and recumbency. The latency to onset of sedation and its duration were also recorded. H2O2 treatment for two weeks significantly decreased glutathione and increased malondialdehyde concentrations in plasma and whole brain of the chicks on days 7, 10 and 14 as compared with respective age-matched control groups. H2O2 decreased the median effective doses of diazepam and xylazine for the induction of sedation in chicks by 46% and 63%, respectively. Injection of diazepam at 2.5, 5 and 10 mg/kg, i.m. or xylazine at 2, 4 and 8 mg/kg, i.m. induced sedation in both control and H2O2-treated chicks in a dose dependent manner, manifested by the above given signs of sedation. H2O2 significantly decreased the latency to onset of sedation in chicks treated with diazepam at 5 and 10 mg/kg, increased the duration of sedation and prolonged the total recovery time in comparison with respective non-stressed control chicks. A similar trend occurred with xylazine in the H2O2-treated chicks, though the differences from control counterparts did not attain the statistical significance, except for the recovery time of the lowest dose of the drug. The data suggest that H2O2-induced oxidative stress sensitizes the chicks to the depressant action of the sedatives diazepam and xylazine. Further studies are needed to examine the potential role of oxidative stress in modulating the actions of therapeutic agents on the brain.

scholarly journals The Effect of Midazolam Pre-Medication on Rocuronium-Induced Neuromuscular Blockade

2002 ◽  
Vol 30 (3) ◽  
pp. 318-321 ◽  
Author(s):  
H Hepağuşlar ◽  
S Öztekin ◽  
Ö Mavioğlu ◽  
B Tuncali ◽  
Z Elar
Keyword(s):  
Neuromuscular Blockade ◽  
Time Course ◽  
Elective Surgery ◽  
Control Group ◽  
Duration Of Action ◽  
Sevoflurane Anaesthesia ◽  
Related Data ◽  
Course Of Action ◽  
Train Of Four ◽  
Neuromuscular Responses

We investigated the effect of midazolam pre-medication on rocuronium-induced neuromuscular blockade during sevoflurane anaesthesia. Twenty-two patients scheduled for elective surgery were randomly divided to receive either no pre-medication (control group) or pre-medication with 0.1 mg/kg midazolam intramuscularly (midazolam group). Anaesthesia was induced with fentanyl and propofol, and maintained with sevoflurane and nitrous oxide in oxygen. Neuromuscular responses were monitored using acceleromyography. The onset and clinical duration of action, time to recovery of first twitch of train-of-four (TOF) response to 75% of control, recovery index and time for TOF recovery to 25% and 50% were recorded. Patient-related data were similar in both groups. The parameters recorded were not significantly different between the groups. Midazolam pre-medication does not influence the time-course of action of rocuronium during sevoflurane anaesthesia.

scholarly journals Clinical Experience with Atracurium during Prolonged Anaesthesia

1989 ◽  
Vol 17 (3) ◽  
pp. 280-284 ◽  
Author(s):  
P. Staun ◽  
L. I. Eriksson ◽  
I. Cederholm ◽  
C. Lennmarken
Keyword(s):  
Recovery Time ◽  
Bolus Dose ◽  
Repeated Administration ◽  
Control Group ◽  
Adductor Pollicis Muscle ◽  
Duration Of Effect ◽  
Isoflurane Group ◽  
Recovery Times ◽  
Train Of Four ◽  
Constant Interval

The pharmacodynamic properties of repeated injections of atracurium were studied in twenty-two patients. A control group received narcotic-based anaesthesia while another group received the same narcotic-based anaesthesia subsequently modified by the addition of 0.5% isoflurane. The twitch response of the adductor pollicis muscle was recorded after train-of-four (TOF) stimulation of the ulnar nerve at the wrist. Duration of effect and recovery time were measured. A bolus dose of atracurium (0.5 mg/kg b.w.) was given for tracheal intubation and maintenance doses of 0.2 mg/kg b.w. were given during anaesthesia at a TOF ratio of 0.25. Mean duration of anaesthesia was 7.5 hours (range 3–19). In the control group mean duration of effect and mean recovery time remained unchanged (six doses studied). A noteworthy inter-individual variation was found. In the isoflurane group mean duration of effect increased from 36.1 (SD 6.3) minutes to 42.2 (SD 8.1) minutes (P<0.05) following the addition of isoflurane. Corresponding recovery times remained unchanged. We conclude that during repeated administration of atracurium during narcotic-based anaesthesia, each patient shows a constant interval between requirements for maintenance doses of atracurium of 0.2 mg/kg b.w. Addition of 0.5% isoflurane causes a moderate prolongation of the duration of effect, but recovery time remains unchanged.

scholarly journals Reversal of Rocuronium-induced (1.2 mg/kg) Profound Neuromuscular Block by Sugammadex

2007 ◽  
Vol 107 (2) ◽  
pp. 239-244 ◽  
Author(s):  
Hans D. de Boer ◽  
Jacques J. Driessen ◽  
Marco A. E. Marcus ◽  
Hans Kerkkamp ◽  
Marten Heeringa ◽  
...  
Keyword(s):  
Adverse Events ◽  
Neuromuscular Blockade ◽  
Recovery Time ◽  
Neuromuscular Block ◽  
Dependent Manner ◽  
Physical Status ◽  
Serious Adverse Events ◽  
Train Of Four ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Reversal of rocuronium-induced neuromuscular blockade can be accomplished by chemical encapsulation of rocuronium by sugammadex, a modified gamma-cyclodextrin derivative. This study investigated the efficacy and safety of sugammadex in reversing rocuronium-induced profound neuromuscular blockade at 5 min in American Society of Anesthesiologists physical status I and II patients. Methods Forty-five American Society of Anesthesiologists physical status I and II patients (aged 18-64 yr) scheduled to undergo surgical procedures (anticipated anesthesia duration &gt;/= 90 min) were randomly assigned to a phase II, multicenter, assessor-blinded, placebo-controlled, parallel, dose-finding study. Anesthesia was induced and maintained with propofol and an opioid. Profound neuromuscular blockade was induced with 1.2 mg/kg rocuronium bromide. Sugammadex (2.0, 4.0, 8.0, 12.0, or 16.0 mg/kg) or placebo (0.9% saline) was then administered 5 min after the administration of rocuronium. Neuromuscular function was monitored by acceleromyography, using train-of-four nerve stimulation. Recovery time was the time from the start of administration of sugammadex or placebo, to recovery of the train-of-four ratio to 0.9. Safety assessments were performed on the day of the operation and during the postoperative and follow-up period. Results A total of 43 patients received either sugammadex or placebo. Increasing doses of sugammadex reduced the mean recovery time from 122 min (spontaneous recovery) to less than 2 min in a dose-dependent manner. Signs of recurrence of blockade were not observed. No serious adverse events related to sugammadex were reported. Two adverse events possibly related to sugammadex were reported in two patients (diarrhea and light anesthesia); however, both patients recovered without sequelae. Conclusions Sugammadex rapidly and effectively reversed profound rocuronium-induced neuromuscular blockade in humans and was well tolerated.

Sign in / Sign up

Export Citation Format

Share Document