scholarly journals The effect of cold-chain re-introduction on the molecular integrity of rocuronium bromide

2021 ◽  
Author(s):  
D Vermeulen ◽  
M Wooding ◽  
K Outhoff ◽  
T Dippenaar
Keyword(s):  
Degradation Products ◽  
Rapid Sequence Induction ◽  
Vital Role ◽  
Cold Chain ◽  
Clinical Effects ◽  
Rocuronium Bromide ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Significant Difference ◽  
Temperature Exposure

Introduction: This study aimed to examine the effect of breakages and re-introduction into cold chain on the rocuronium bromide compound. Rocuronium bromide is frequently used in routine theatre lists and plays a vital role in modified rapid sequence induction and intubation for emergency patients who have contraindications to the primarily used muscle relaxant, succinylcholine. With the current practice of removing the drug from, and then reintroducing it into the cold chain, unpredictable clinical effects, including delayed onset of action and shortened duration of action have been observed. This may pose significant risks to the patient. Methods: Rocuronium bromide was subjected to different clinically applicable storage and temperature scenarios, after which the compound was analysed for integrity and quantities of the active compound, including detection of possible degradation products, by mass spectrometry, and compared to cold chain control samples. Results: There were no significant differences between any of the temperature exposure groups (18 °C or 24 °C) or between single or double exposures at these temperatures. No statistically significant difference could be demonstrated between the two control groups (cold chain preserved and room temperature controlled) with testing done at weeks one and six. However, week twelve analysis revealed a statistically significant result which translates to a 26 μg/ml difference, which clinically would have no effect. Substantial results were obtained with a secondary exposure to air; which lead to a 20% decrease in rocuronium concentration (p = 0.02). Conclusion: Practice should be adapted by keeping careful documentation as to when cold-chain was broken, and when the recommended 12 week period will lapse. Vial sharing as a standard is not recommended. If small quantities are repeatedly withdrawn from the vial during a prolonged case, the unused contents should be discarded after eight hours.

scholarly journals A clinical comparison of high dose and low dose of Suxamethonium

2014 ◽  
Vol 9 (2) ◽  
pp. 1-8
Author(s):  
RK Yadav ◽  
PC Majhi ◽  
D Tiwari
Keyword(s):  
Intraocular Pressure ◽  
Dose Group ◽  
Low Dose ◽  
Cardiovascular Responses ◽  
High Dose ◽  
Clinical Effects ◽  
Duration Of Action ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Background: Suxamethonium having its rapid onset and short duration of action makes this drug unique amongst the neuromuscular blocking drugs described so far. However, use of suxamethonium is associated with a large number of undesirable side effects. Objective: To evaluate clinical effects of high and low dose of suxamethonium and to determine whether lower dose of suxamethonium can be used for any beneficial effects in terms of its various adverse effects e.g. cardiovascular responses, post-operative muscle pains and intraocular pressure. Methods: A total of 100 patients were included in this prospective study. All these patients on preoperative clinical evaluation were assessed to have adequate airway. All the patients were divided in two groups, low dose group (group I) and High dose group (group II) with 50 patients in each at random. A standard anesthetic technique was adhered to all the patients and following parameters were observed on comparative basis: a. Fasciculation and post operative myalgia. b. Cardiovascular effects, c. Intraocular pressure. Observation: The incidence of post Suxamethonium pain was significantly greater in group II. Increase in heart rate from baseline was significant in both groups. There was no significant difference between the two groups in the diastolic pressure but rise in systolic blood pressure was significant at all assessment times in both groups. This rise from control was statistically significant. Conclusion: Suxamethonium can be used in lower doses (0.5 mg/kg) in elective cases without airway compromise. It gives benefits of reduced muscle pains, cardiovascular responses and intraocular hypertension. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 1-8 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9677

scholarly journals A prospective randomized comparative study of the efficacy of sustained release vaginal insert versus intracervical gel in primigravidae at term pregnancy

2020 ◽  
Vol 9 (4) ◽  
pp. 1532
Author(s):  
Thejaswi R. Thupakula ◽  
Bela Makhija ◽  
Arpana Haritwal
Keyword(s):  
Sustained Release ◽  
Dropout Rate ◽  
Cold Chain ◽  
Clinical Effects ◽  
Term Pregnancy ◽  
Duration Of Action ◽  
Successful Induction ◽  
Group A ◽  
Consecutive Term ◽  
Group B

vBackground: Induction of labour is the intentional initiation of labour before spontaneous onset for the purpose of delivery of fetoplacental unit. Failure of induction is responsible for increased incidence of caesarean delivery. This study performed to assess and compare the clinical effects of sustained release vaginal insert versus intracervical gel in primiparous women with term pregnancy in terms of improvement of Bishop’s score, Induction delivery interval, incidence of hyperstimulation, maternal and neonatal outcomes.Methods: A total 100 consecutive term pregnant women who underwent labor induction for fetal or maternal indications were divided randomly into two groups. Group A - sustained release Vaginal insert and Group B - Intracervical gel. Informed consent was taken from each patient.Results: Statistically significant increase in final Bishop’s score (p=0.008) and hyperstimulation (p=0.04) was seen in Vaginal insert group as compared to Intracervical gel group, while there were no statistically significant differences in maternal outcomes, neonatal outcomes and need for oxytocin augmentation in both groups.Conclusions: In this study we found that insert did not improve the induction delivery interval or rate of successful induction, nor did it have any advantage in terms of neonatal outcome although it did improve the Bishops score – Its advantage was in terms of single application, few prevaginal examinations, longer duration of action and immediate retrieval in case of hyperstimulation. Its main drawback remained the maintenance of cold chain without which its efficacy decreases. Another significant observation was the dropout rate of insert (16%).

scholarly journals Effect of Nutritional Status on Vecuronium Induced Neuromuscular Blockade

1998 ◽  
Vol 26 (4) ◽  
pp. 392-395 ◽  
Author(s):  
S. Sinha ◽  
A. K. Jain ◽  
A. Bhattacharya
Keyword(s):  
Nutritional Status ◽  
Neuromuscular Blockade ◽  
Marked Effect ◽  
Elective Surgery ◽  
Severe Malnutrition ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Significant Difference ◽  
Train Of Four ◽  
Time To Onset

Based on simple clinical and biochemical parameters of nutritional status, seventy adult patients scheduled for elective surgery under general anaesthesia were categorized as having normal nutrition, mild, moderate or severe malnutrition or obesity Under anaesthesia, evoked responses on train-of-four nerve stimulation were recorded every 15 seconds on a mechanomyograph. Vecuronium 0.1 mg.kg-1 was used to achieve neuromuscular blockade. Compared with patients having normal nutrition, the time to onset of action was significant& prolonged in the moderate and severely malnourished groups; the time to no response on train-of-four stimulation was delayed only in severely malnourished groups (P<0.001). The duration of action of the initial dose was shorter in the moderate and severely malnourished groups. The obese group had an earlier onset of action and a longer duration of action compared with patients of normal nutrition (P<0.001). No significant difference in recovery time to a train-of-four ratio of 0.70 was observed between the malnourished and patients with normal nutrition. Malnutrition hus a marked effect on vecuronium-induced neuromuscular blockade.

scholarly journals MULA KERJA ROKURONIUM

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Sadrakh Tompodung ◽  
Harold F. Tambajong ◽  
Diana Lalenoh
Keyword(s):  
Muscle Relaxant ◽  
Random Sampling ◽  
Simple Random Sampling ◽  
Induction Agent ◽  
Anaesthetic Induction ◽  
Onset Of Action ◽  
Chi Square ◽  
Duration Of Action ◽  
Significant Difference ◽  
Chi Square Test

Abstract: Endotracheal intubation needs a muscle relaxant to permit the pipe to get easily into the trachea. Injury of the respiratory tract during this procedure can be avoided by being cognizant of the onsets of action of certain muscle relaxants. Rocuronium is a non-depolarization muscle relaxant with intermediate duration of action and fewer side effects. This study aimed to find out the onset of action of rocuronium. This was an observational study conducted in the operation rooms of Prof. Dr. R.D. Kandou Hospital from November 2012 to January 2013. Samples were patients with ASA 1-2, aged 18 40 years who had been selected by using simple random sampling methods. Midazolam 0,7 mg/kg BW and fentanyl 2 µg/kg BW were used as premedication agents; propofol 2 mg/kg BW as an anaesthetic induction agent; and rocuronium 0,6 mg/kg BW as the muscle relaxant. The rocuronium’s onset of action was measured by using TOF-Watch after the injection of rocuronium until the percentage of muscle relaxation was 0. The results showed that the onset of action in 17 samples (14 females and 3 males) was 151 seconds. The onset of action in females was 65 seconds shorter than in males. A correlation test (P = 0.857) and the chi-square test (P = 0.434) showed no significant correlation between age and the onset of action. There was a significant difference (P < 0.05) between the onset of action and sex showed by the t-test (P = 0.023) and the chi-square test (P = 0.035). Conclusion: The average onset of action of rocuronium was 2 minutes and 31 seconds, with  females having a shorter onset of action of rocuronium. Keywords: onset of action, rocuronium.     Abstrak: Pemasangan pipa trakea memerlukan obat pelumpuh otot untuk memudahkan pipa ini masuk ke saluran napas. Cedera saluran napas akibat pemasangan pipa trakea dapat dihindari dengan mengetahui mula kerja (onset of action) dari obat pelumpuh otot. Rokuronium merupakan obat pelumpuh otot jenis non-depolarisasi dengan lama kerja sedang tanpa efek samping bagi tubuh. Penelitian ini bertujuan untuk mengetahui mula kerja rokuronium dan dilakukan di ruang operasi Rumah Sakit Prof Dr. R.D. Kandou Manado sejak bulan Nopember 2012 hingga Januari 2013. Sampel ialah pasien dengan ASA 1-2, berusia 18-40 tahun, yang dipilih secara simple random sampling. Pasien dipremedikasi dengan midazolam 0,7 mg/kg BB dan fentanil 2 µg/kg BB, diinduksi dengan propofol 2 mg/kg BB dan kemudian diberikan rokuronium 0,6 mg/kg BB secara intra vena. Mula kerja rokuronium diukur antara selesai penyuntikan hingga persentase kelumpuhan otot pada TOF-watch mencapai 0. Hasil penelitian memperlihatkan pada 17 sampel (14 orang perempuan dan 3 orang laki-laki), rerata mula kerja rokuronium 151 detik. Mula kerja rokuronium pada perempuan 65 detik lebih singkat daripada laki-laki. Hasil uji korelasi (P = 0,857) dan uji chi-square (P = 0,434) memperlihatkan tidak terdapat korelasi bermakna antara usia dan mula kerja rokuronium. Terdapat perbedaan bermakna (P < 0,05) antara mula kerja rokuronium dan jenis kelamin yang ditunjukkan dengan uji t (P = 0,023) dan uji chi-square (P = 0,035). Simpulan: Rerata mula kerja rokuronium dengan dosis 0,6 mg/kg BB untuk kedua jenis kelamin 2 menit 31 detik. Perempuan mempunyai mula kerja rokuronium lebih singkat daripada laki-laki. Kata kunci: mula kerja, rokuronium.

Toxicity of Local Anesthetics in Hair Transplantation and Facial Plastic Surgery

1997 ◽  
Vol 14 (4) ◽  
pp. 453-456 ◽  
Author(s):  
Thomas G. Bruno ◽  
Joseph F. Greco
Keyword(s):  
Plastic Surgery ◽  
Local Anesthetics ◽  
Adverse Reactions ◽  
Clinical Effects ◽  
Hair Transplantation ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Facial Plastic Surgery ◽  
Anesthetic Drugs ◽  
Facial Plastic

The tendency toward the use of local anesthetics for longer outpatient procedures such as hair transplantation micrograft megasessions and cosmetic facial plastic surgery calls for special consideration of potential toxicity and adverse reactions. As longer procedures on larger, highly vascular surface areas are attempted, the potential for adverse reactions becomes more likely. Understanding the pharmacological properties that govern the clinical effects of local anesthetics, such as onset of action, duration of action, and adverse effects, will prompt the clinician to carefully consider the technique of administration and the dosing limits of these potentially toxic anesthetic drugs.

Geographic Regional Differences in Rocuronium Bromide Dose–Response Relation and Time Course of Action

2006 ◽  
Vol 104 (5) ◽  
pp. 950-953 ◽  
Author(s):  
Ashraf A. Dahaba ◽  
Seth I. Perelman ◽  
David M. Moskowitz ◽  
Henry L. Bennett ◽  
Aryeh Shander ◽  
...  
Keyword(s):  
Dose Response ◽  
Time Course ◽  
Neuromuscular Block ◽  
Chinese Patients ◽  
Ambient Conditions ◽  
Response Curves ◽  
Rocuronium Bromide ◽  
Duration Of Action ◽  
Significant Difference ◽  
Geographic Regions

Background Geographic location is not acknowledged as a stratifying factor that can directly affect drug potency, because drugs are still licensed with the same recommended dose for different geographic regions. The aim of the current study was to compare the potency and duration of action of rocuronium bromide in 54 patients in three countries with different life habits, diet, and ambient conditions, namely white Austrians, white North Americans, and Han Chinese in China. Methods Neuromuscular block of six consecutive 50-microg/kg rocuronium incremental doses followed by 300 microg/kg was evaluated using the Relaxometer mechanomyograph (Groningen University, Groningen, Holland). Dose-response curves were created using log-dose-probit transformation. The authors compared rocuronium bromide ED50, ED90, and ED95 (effective doses required for 50%, 90%, and 95% first twitch depression, respectively) as well as Dur25 and Dur0.8 (times from last incremental dose administration until 25% first twitch and 0.8 train-of-four ratio recovery, respectively) in patients of the three countries. Results Rocuronium ED50, ED90, and ED95 were significantly higher in Austrian patients (258 +/- 68, 530 +/- 159, and 598 +/- 189 microg/kg) and Chinese patients (201 +/- 59, 413 +/- 107, and 475 +/- 155 microg/kg) compared with American patients (148 +/- 48, 316 +/- 116, and 362 +/- 149 microg/kg, respectively). Dur25 and Dur0.8 were significantly shorter in Austrian patients (22.3 +/- 5.5 and 36.9 +/- 12.8 min) and Chinese patients (30.4 +/- 7.5 and 45.7 +/- 15.9 min) compared with American patients (36.7 +/- 8.5 and 56.2 +/- 16.7 min, respectively). Conclusions The authors demonstrated a significant difference in rocuronium potency and duration of action among patients in the three countries. Larger studies are required for determining dosage recommendations for different geographic regions.

scholarly journals COMPARISON OF HEMODYNAMIC AND NEUROMUSCULAR PROPERTIES OF ROCURONIUM VERSUS VECURONIUM IN ANESTHESIA

2021 ◽  
pp. 1-3
Author(s):  
Rajeev Krishan ◽  
Praveen Kumar Singh ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Blood Pressure ◽  
General Anesthesia ◽  
Onset Time ◽  
Cardiovascular Effects ◽  
Neuromuscular Blocking ◽  
Vecuronium Bromide ◽  
Rocuronium Bromide ◽  
Duration Of Action ◽  
Hemodynamic Variables ◽  
Significant Difference

Background: Adequate maintenance of airways in patients undergoing surgeries under general anesthesia was through proper intubation. This was achieved by the extensive usage of neuromuscular blocking drugs, which provided good intubation conditions and relaxation of the muscles. Neuromuscular blockers play a key role in general anesthesia. Rocuronium and vecuronium are used as nondepolarizing muscle relaxants. Objective: To study the neuromuscular properties and cardiovascular effects of rocuronium bromide, the “near-ideal” muscle relaxant and to compare it with vecuronium bromide, an already established drug, during anesthesia. Materials and Methods: This prospective, randomized double-blinded clinical study included 50 patients, 25 patients received 0.6 mg/kg of rocuronium bromide for the maintenance of anesthesia and the other 25 patients received 0.1 mg/kg of vecuronium bromide. The top-up doses administered were 0.15 mg/kg of rocuronium and 0.025 mg/kg of vecuronium. Result: The onset time was significantly shorter in the rocuronium group (Mean ± standard deviation [SD] was 108.8 s ± 28.875 s) compared with vecuronium group (Mean ± SD 188.76 s± 43.78 s). The duration of action of first dose was significantly longer in rocuronium group (31.5 min) compared with vecuronium group (24.5 min).The duration of action of top-up doses was similar in both the groups (p>0.05). There was no significant difference in any of the haemodynamic variables between the two groups. Conclusion: The duration of action of top-up doses was similar in both the groups (p > 0.05). There was no significant difference in any of the hemodynamic variables (heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure) between the two groups.

Immunoreactivity of Tissue Plasminogen Activator and of Its Inhibitor Complexes

1989 ◽  
Vol 61 (03) ◽  
pp. 409-414 ◽  
Author(s):  
M Rånby ◽  
G Nguyen ◽  
P Y Scarabin ◽  
M Samama
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Degradation Products ◽  
Gel Filtration ◽  
Free Form ◽  
Enzyme Linked Immunosorbent Assay ◽  
Plasma Samples ◽  
Significant Difference ◽  
Tissue Plasminogen ◽  
Pai 1

SummaryAn enzyme linked immunosorbent assay (ELISA) based on goat polyclonal antibodies against human tissue plasminogen activator (tPA) was evaluated. The relative immunoreactivity of tPA in free form and tPA in complex with inhibitors was estimated by ELISA and found to be 100, 74, 94, 92 and 8l% for free tPA and tPA in complex with PAI-1, PAI-2, α2-antiplasmin and C1-inhibitor, respectively. Addition of tPA to PAI-1 rich plasma resulted in rapid and total loss of tPA activity without detectable loss of ELISA response, indicating an immunoreactivity of tPA in tPA/PAI-1 complex of about l00%. Three different treatments of citrated plasma samples (acidification/reneutralization, addition of 5 mM EDTA or of 0.5 M lysine) prior to determination by ELISA all resulted in increased tPA levels. The fact that the increase was equally large in all three cases along with good analytical recovery of tPA added to plasffi, supported the notion that all tPA antigen present in plasma samples is measured by the ELISA. Analysis by ELISA of fractions obtained by gel filtration of plasma from a patient undergoing tPA treatment identified tPA/inhibitor complexes and free tPA but no low molecular weight degradation products of tPA. Determinations of tPA antigen were made at seven French clinical laboratories on coded and randomized plasma samples with known tPA antigen content. For undiluted samples there was no significant difference between the tPA levels found and those known to be present. The between-assay coefficient of variation was 7 to 10%. In conclusion, the ELISA appeared suited for determination of total tPA antigen in human plasma samples.

Service Quality Perception towards E-CRM Practices among Customers of Private and Public Sector Banks of Rajasthan Using SERVQUAL Method

2018 ◽  
Vol 7 (3) ◽  
pp. 22
Author(s):  
Neeti Kasliwal ◽  
Jagriti Singh
Keyword(s):  
Public Sector ◽  
Service Quality ◽  
Banking Sector ◽  
Sampling Technique ◽  
Vital Role ◽  
Public Sector Banks ◽  
Significant Difference ◽  
Private And Public ◽  
Score Method ◽  
Public Banks

Banking sector is growing rapidly and playing a vital role in the economic development of the nation. Both private and public sector banks are giving more priority to service quality to satisfy their customers. For this, banks are now emphasizing on E-CRM practices to carry out transactions and communicate with their customers. The purpose of this research is to assess the service quality among private and public banks in Rajasthan. Purposive sampling technique has been employed to collect the data from three private banks and three banks from public. To analyze the data, descriptive statistics, Mean score method and t test have been used. Results indicates that there is a significant difference in consumer’s perception of service quality dimensions related to E-CRM practices provided by selected private and public sector banks of Rajasthan..The findings of this research will help policy makers of banking sector to set customer oriented policies.

scholarly journals A Milk Foodomics Investigation into the Effect of Pseudomonas fluorescens Growth under Cold Chain Conditions

Foods ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 1173
Author(s):  
Paolo Bellassi ◽  
Gabriele Rocchetti ◽  
Lorenzo Morelli ◽  
Biancamaria Senizza ◽  
Luigi Lucini ◽  
...  
Keyword(s):  
Pseudomonas Fluorescens ◽  
Degradation Products ◽  
Storage Conditions ◽  
Cold Chain ◽  
Lower Sensitivity ◽  
Multivariate Statistical ◽  
Proteolytic Activities ◽  
Quality Of Milk ◽  
Potential Tool

Pseudomonas fluorescens is a psychrotrophic species associated with milk spoilage because of its lipolytic and proteolytic activities. Consequently, monitoring P. fluorescens or its antecedent activity in milk is critical to preventing quality defects of the product and minimizing food waste. Therefore, in this study, untargeted metabolomics and peptidomics were used to identify the changes in milk related to P. fluorescens activity by simulating the low-temperature conditions usually found in milk during the cold chain. Both unsupervised and supervised multivariate statistical approaches showed a clear effect caused by the P. fluorescens inoculation on milk samples. Our results showed that the levels of phosphatidylglycerophosphates and glycerophospholipids were directly related to the level of contamination. In addition, our metabolomic approach allowed us to detect lipid and protein degradation products that were directly correlated with the degradative metabolism of P. fluorescens. Peptidomics corroborated the proteolytic propensity of P. fluorescens-contaminated milk, but with lower sensitivity. The results obtained from this study provide insights into the alterations related to P. fluorescens 39 contamination, both pre and post heat treatment. This approach could represent a potential tool to retrospectively understand the actual quality of milk under cold chain storage conditions, either before or after heat treatments.

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