scholarly journals Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

2021 ◽  
Vol 9 (2) ◽  
pp. 21
Author(s):  
Cyrus Motamed ◽  
Migena Demiri ◽  
Nora Colegrave
Keyword(s):  
Neuromuscular Blockade ◽  
Lower Limit ◽  
Elective Surgery ◽  
Orotracheal Intubation ◽  
Neuromuscular Blocking ◽  
Physical Status Classification ◽  
Train Of Four ◽  
Surgery First ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

Neuromuscular blockade effects of cisatracurium in 11 cats undergoing ophthalmological surgery anaesthetised with isoflurane

2021 ◽  
pp. 1098612X2110218
Author(s):  
Anne-Sophie Van Wijnsberghe ◽  
Keila K Ida ◽  
Petra Dmitrovic ◽  
Alexandru Tutunaru ◽  
Charlotte Sandersen
Keyword(s):  
Neuromuscular Blockade ◽  
Case Series ◽  
Neuromuscular Function ◽  
Duration Of Action ◽  
Cardiovascular Side Effects ◽  
Train Of Four ◽  
Physical Classification ◽  
The Mean ◽  
American Society ◽  
American Society Of Anesthesiologists

Case series summary This case series describes the neuromuscular blockade (NMB) following 0.15 mg/kg intravenous (IV) cisatracurium administration in 11 cats undergoing ophthalmological surgery and anaesthetised with isoflurane. Anaesthetic records were analysed retrospectively. Neuromuscular function was assessed by a calibrated train-of-four (TOF) monitor. Cats were 73 ± 53 months old, weighed 4 ± 1 kg and were of American Society of Anesthesiologists’ physical classification 2. Duration of anaesthesia and surgery were 144 ± 27 and 94 ± 24 mins, respectively. The lowest TOF count was zero in four cats, four in six cats and for one cat the TOF ratio never decreased below 31%. The time of onset was between 1 and 6 mins after the administration of cisatracurium and the mean duration of action was 20.4 ± 10.1 mins. Relevance and novel information Cisatracurium at a dose of 0.15 mg/kg IV did not consistently induce a TOF count of zero in all cats. The dose used in these cats did not produce any remarkable cardiovascular side effects. Although the NMB was not complete, the dose given was sufficient to produce central eyeball position, which was the goal of the ophthalmic surgeries.

Comparative Clinical Pharmacology of Rocuronium, Cisatracurium, and Their Combination 

1998 ◽  
Vol 89 (5) ◽  
pp. 1116-1124 ◽  
Author(s):  
Mohamed Naguib ◽  
Abdulhamid H. Samarkandi ◽  
Adel Ammar ◽  
S. R. Elfaqih ◽  
Salem Al-Zahrani ◽  
...  
Keyword(s):  
Clinical Pharmacology ◽  
Time Course ◽  
Time Profile ◽  
Neuromuscular Blocking ◽  
Combination Group ◽  
Onset Of Action ◽  
Recovery Times ◽  
Train Of Four ◽  
American Society ◽  
American Society Of Anesthesiologists

Background The comparative clinical pharmacology of cisatracurium and rocuronium and their combinations has not been reported. In this study, the authors compared the relative potency and the clinical profile and characterized the interaction of both drugs. Methods Two hundred twenty adults classified as American Society of Anesthesiologists physical status I and anesthetized with propofol-fentanyl-nitrous oxide were studied. In part 1, the neuromuscular-blocking effects of cisatracurium and rocuronium were assessed after administration of bolus doses of 20-50 microg/kg and 100-300 microg/kg, respectively. In part 2, we compared the time course of 1xED50, 1, 1.5, and 2xED95 doses of both drugs (where ED50 and ED95 are, respectively, the doses producing 50% and 95% depression of the first twitch height [T1]). In part 3, equieffective combinations of both drugs were studied to characterize their interaction. Results The calculated ED50 values and their 95% confidence intervals were 111 (107-115) and 26.2 (25.8-26.5) microg/kg [corrected] for rocuronium and cisatracurium, respectively. Compared with equipotent doses of cisatracurium, rocuronium had a faster onset, and a faster spontaneous T1 and train-of-four recovery times that were significant except at maximum recovery with the 2xED95 dose. The interaction between rocuronium and cisatracurium was synergistic, and the time profile of the combination group was different from that of the single-dose groups. Conclusions Cisatracurium is four to five times more potent than rocuronium. Rocuronium had a faster onset of action, a shorter clinical duration, and a faster spontaneous recovery rate compared with equipotent doses of cisatracurium.

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 >/= 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.

Reversal of Profound Rocuronium-induced Blockade with Sugammadex

2008 ◽  
Vol 109 (5) ◽  
pp. 816-824 ◽  
Author(s):  
R Kevin Jones ◽  
James E. Caldwell ◽  
Sorin J. Brull ◽  
Roy G. Soto
Keyword(s):  
Neuromuscular Blockade ◽  
Geometric Mean ◽  
Randomized Study ◽  
Acetylcholinesterase Inhibitors ◽  
Neuromuscular Blocking ◽  
Phase Iii ◽  
Reversal Agent ◽  
Train Of Four ◽  
American Society ◽  
Intent To Treat

Background Traditionally, reversal of nondepolarizing neuromuscular blocking agents was achieved using acetylcholinesterase inhibitors, but these are unable to adequately reverse profound blockade. Sugammadex is a novel reversal agent, reversing the effects of rocuronium by encapsulation. This study assessed the efficacy and safety of sugammadex versus neostigmine for reversal of profound rocuronium-induced neuromuscular blockade. Methods This phase III, randomized study enrolled surgical patients, aged 18 yr or older with American Society of Anesthesiologists physical status I-IV. Patients were randomized to receive sugammadex (4.0 mg/kg) or neostigmine (70 microg/kg) plus glycopyrrolate (14 microg/kg). Anesthetized patients received an intubating dose of rocuronium (0.6 mg/kg), with maintenance doses (0.15 mg/kg) as required. Neuromuscular monitoring was performed by acceleromyography. Sugammadex or neostigmine was administered at reappearance of 1-2 posttetanic counts (profound neuromuscular blockade). The primary efficacy parameter was the time from sugammadex or neostigmine-glycopyrrolate administration to return of the train-of-four ratio to 0.9. Results In the intent-to-treat population (n = 37 in each group), geometric mean time to recovery to a train-of-four ratio of 0.9 with sugammadex was 2.9 min versus 50.4 min with neostigmine-glycopyrrolate (P < 0.0001) (median, 2.7 min vs. 49.0 min). Most sugammadex patients (97%) recovered to a train-of-four ratio of 0.9 within 5 min after administration. In contrast, most neostigmine patients (73%) recovered between 30 and 60 min after administration, with 23% requiring more than 60 min to recover to a train-of-four ratio of 0.9. Conclusions Recovery from profound rocuronium-induced neuromuscular blockade was significantly faster with sugammadex versus with neostigmine, suggesting that sugammadex has a unique ability to rapidly reverse profound rocuronium neuromuscular blockade.

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

2020 ◽  
pp. 000313482097338
Author(s):  
Elizabeth McCarthy ◽  
Benjamin L. Gough ◽  
Michael S. Johns ◽  
Alexandra Hanlon ◽  
Sachin Vaid ◽  
...  
Keyword(s):  
Postoperative Recovery ◽  
Logistic Regression Models ◽  
Community Institution ◽  
Physical Status Classification ◽  
Estimated Blood Loss ◽  
Comparative Review ◽  
Significant Difference ◽  
American Society ◽  
The Individual ◽  
American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

Validation of the Tokyo guideline 2018 treatment proposal for acute cholecystitis from a single-center retrospective analysis

2019 ◽  
Author(s):  
Tomoaki Bekki ◽  
Tomoyuki Abe ◽  
Hironobu Amano ◽  
Keiji Hanada ◽  
Tsuyoshi Kobayashi ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Acute Cholecystitis ◽  
Treatment Strategy ◽  
Early Laparoscopic Cholecystectomy ◽  
Physical Status Classification ◽  
Severity Grading ◽  
Hospital Stays ◽  
Comorbidity Index ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Based on the revised Tokyo guideline 2018 (TG18), early laparoscopic cholecystectomy (LC) is recommended in patients who satisfy the Charlson Comorbidity Index (CCI) criteria and the American Society of Anesthesiologists Physical Status Classification (ASA-PS). Our study aims to determine the efficacy of TG18 treatment strategy. Methods We enrolled 324 patients with acute cholecystitis (AC) diagnosed by TG18 who underwent cholecystectomy between 2010 and 2018. Perioperative variables and surgical outcomes were analyzed according to the TG18 treatment strategy and severity grading. Results ASA-PS scores and CCI were significantly higher in patients with Grade II (GII) and GIII AC. Higher severity grading resulted in failed LC, requiring blood transfusion and bailout surgery. The TG18 within group showed a higher proportion of GI and GII AC and their ASA-PS scores were also significantly lower. TG18 within group demonstrated significant differences in the achievement of LC, bailout surgery, postoperative hospital stays, and 90-day mortality rates. Intraoperative blood loss and blood transfusion were significantly higher in the TG18 outside group than that in the TG18 within group. Conclusions Our study shows that the TG18 treatment strategy is well-designed and efficacious. Novel findings Our study established the feasibility and efficacy of TG18. The usefulness of performing aggressive surgery beyond the TG18 strategy requires further study.

Use of peripheral nerve stimulators to monitor patients with neuromuscular blockade in the ICU

1996 ◽  
Vol 5 (6) ◽  
pp. 449-454 ◽  
Author(s):  
R Kleinpell ◽  
C Bedrosian ◽  
L McCormick ◽  
M Kremer ◽  
L Bujalski ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Neuromuscular Blockade ◽  
National Sample ◽  
Neuromuscular Blocking ◽  
Nerve Stimulator ◽  
Peripheral Nerve Stimulator ◽  
Number Of Patients ◽  
Train Of Four ◽  
Current Monitoring ◽  
Prolonged Neuromuscular Blockade

BACKGROUND: Neuromuscular blockade is a frequently used therapy in the ICU. However, recent reports of prolonged paralysis and general muscular weakness in patients treated with this procedure have raised concerns about its use in intensive care. OBJECTIVE: The purpose of this study was to assess current monitoring practices of nurses who care for patients treated with neuromuscular blockade. METHODS: In January 1995, questionnaires were mailed to a random national sample of 2000 critical care nurses. Of the 2000 questionnaires mailed, 744 were returned. RESULTS: The number of patients per month who were treated with neuromuscular blockade in ICU settings ranged from 0 to 75 (mean = 6.82, SD = 9.15). For each patient, the average number of days of blockade ranged from less than 1 to 63 (mean = 4.12, SD = 3.36). The most common indications for neuromuscular blockade were to assist in mechanical ventilation, reduce oxygen consumption, and treat agitation. Only 41% of respondents (n = 306) reported using train-of-four stimuli and a peripheral nerve stimulator to monitor patients. Depth of neuromuscular blockade was routinely monitored by using clinical assessment (31%), a peripheral nerve stimulator (16%), or both (52%). CONCLUSIONS: Among the respondents, variations existed in monitoring practices and in the use of peripheral nerve stimulators, including the frequency of monitoring and use of the baseline milliamperage. Appropriate monitoring and titration of neuromuscular blocking agents by ICU nurses may aid in preventing adverse effects, including the potential for prolonged neuromuscular blockade. The existing variations in practice may affect patients' outcomes.

scholarly journals Obtenção de Consentimento Informado para Anestesia em Cirurgia Eletiva num Hospital Terciário: Práticas e Contexto Ético-Legal

2019 ◽  
Vol 32 (1) ◽  
pp. 53
Author(s):  
Luís Guilherme Casimiro ◽  
Sara Marisa Pereira ◽  
Sofia Cardoso Pires ◽  
Joana Mourão
Keyword(s):  
Informed Consent ◽  
Elective Surgery ◽  
University Hospital ◽  
Anesthetic Technique ◽  
Patient Relationship ◽  
Active Process ◽  
Legal Principles ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Written Informed Consent

Introduction: Informed consent is an active process of the doctor-patient relationship, based on ethical and legal principles. The anesthetic act has inherent risks, which should be subject of specific consent. The aim of this study was to evaluate the degree of implementation of written specific informed consent for anesthesia in the context of elective surgery.Material and Methods: An observational prospective study, at a tertiary university hospital, in 230 patients aged 60 years or older, undergoing elective surgery between May and July 2017. Eligible patients who consented to participate were interviewed clinically on the day before surgery. In the postoperative period, the anesthetic technique and the existence of the written informed consent for the anesthetic and surgical procedures were assessed. Patients who were unable to give informed consent or those admitted in the Intensive Care Unit after surgery were excluded. Results: Written informed consent for the surgical procedure was obtained for 225 (97.8%), while it was obtained in just 96 (41.7%) patients for the anesthetic act. There was a higher prevalence of stroke, anemia, and higher Charlson and physical American Society of Anesthesiologists scores in patients without written informed consent for the anesthetic act.Discussion: We identified a low implementation of written informed consent for anesthesia. This situation may have important implications in the context of disciplinary, civil or criminal liability.Conclusion: Despite its importance, the practice of written informed consent for anesthesia in this institution is not yet implemented on a regular basis.

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