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.

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 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 Efficacy, Safety, and Pharmacokinetics of Sugammadex for the Reversal of Rocuronium-induced Meeting Abstracts in Elderly Patients

2011 ◽  
Vol 114 (2) ◽  
pp. 318-329 ◽  
Author(s):  
David L. McDonagh ◽  
Patrick E. Benedict ◽  
Anthony L. Kovac ◽  
David R. Drover ◽  
Neil W. Brister ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Neuromuscular Blockade ◽  
Geometric Mean ◽  
Anesthesia Induction ◽  
Elderly Adult ◽  
Open Label ◽  
Class 1 ◽  
Train Of Four ◽  
Neuromuscular Blockade Reversal ◽  
American Society

Background The management of elderly patients can be challenging for anesthesiologists for many reasons, including altered pharmacokinetics and dynamics. This study compared the efficacy, safety, and pharmacokinetics of sugammadex for moderate rocuronium-induced neuromuscular blockade reversal in adult (aged 18-64 yr) versus elderly adult (aged 65 yr or older) patients. Methods This phase 3a, multicenter, parallel-group, comparative, open-label study enrolled 162 patients aged 18 yr and older, American Society of Anesthesiologists class 1-3, scheduled for surgery with general anesthesia and requiring neuromuscular blockade. After anesthesia induction, patients received rocuronium, 0.6 mg/kg, before tracheal intubation, with maintenance doses of 0.15 mg/kg as required. At the end of surgery, patients received sugammadex, 2.0 mg/kg, at reappearance of the second twitch of the train-of-four (TOF) for reversal. The primary efficacy variable was time from sugammadex administration to recovery of the TOF ratio to 0.9 or greater. Pharmacokinetics and safety were also evaluated. Results Overall, 150 patients were treated and had at least one postbaseline efficacy assessment; 48 were aged 18-64 yr (adult), 62 were aged 65-74 yr (elderly), and 40 were aged 75 yr or older (old-elderly). The geometric mean time (95% confidence interval) from sugammadex administration to recovery of the TOF ratio to 0.9 increased with age, from 2.3 (2.0-2.6) min (adults) to 2.9 (2.7-3.2) min (elderly/old-elderly groups combined). Recovery of the TOF ratio to 0.9 was estimated to be 0.7 min faster in adults compared with patients aged 65 yr or older (P = 0.022). Sugammadex was well tolerated by all patients. Conclusion Sugammadex facilitates rapid reversal from moderate rocuronium-induced neuromuscular blockade in adults of all ages.

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.

scholarly journals Comparison of tactile and mechanomyo-graphical assessment of response to double burst and train-of-four stimulation during moderate and profound neuromuscular blockade

1995 ◽  
Vol 42 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Hans Kirkegaard-Nielsen ◽  
Hans Søren Helbo-Hansen ◽  
Inge Krogh Severinsen ◽  
Peter Lindholm ◽  
Henrik Stougaard Pedersen ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Train Of Four

scholarly journals Mechanical Thrombectomy in Stroke. Experience from Switching from Stent Retriever Only to Stent Retriever Combined with Aspiration Catheter

2021 ◽  
Vol 10 (9) ◽  
pp. 1802
Author(s):  
Grzegorz Meder ◽  
Paweł Żuchowski ◽  
Wojciech Skura ◽  
Violetta Palacz-Duda ◽  
Milena Świtońska ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Statistical Significance ◽  
Stent Retriever ◽  
Single Center Experience ◽  
Significant Difference ◽  
First Pass ◽  
Need To Evaluate ◽  
The Difference

Endovascular treatment is a rapidly evolving technique; therefore, there is a constant need to evaluate this method and its modifications. This paper discusses a single-center experience and the results of switching from the stent retriever only (SO) mechanical thrombectomy (MT) to the combined approach (CA), with a stent retriever and aspiration catheters. Methods: The study involved a retrospective analysis of 70 patients undergoing MT with the use of either SO or CA. The primary endpoint was the frequency of perfect reperfusion defined as grade 3 of the modified Thrombolysis in Cerebral Infarction scale (mTICI) after the first pass. The secondary endpoints were the procedure success, defined as mTICI grades 2b-3; time of the procedure; clinical outcome, measured by 90 days’ modified Rankin Scale (mRS) score; Δ NIHSS, defined as the difference between National Institutes of Health Stroke Scale (NIHSS) score at patients’ admission and discharge; and the total number of device passes. Results: Out of the 70 patients included, 33 were treated with SO and 37 with CA. In both groups, a total number of 42 patients received intravenous recombined tissue plasminogen activator (iv-rTPA: 20 patients (60.6%) in the SO group and 22 patients (59.5%) in the CA group (p = 1.000). There was a significant difference between the groups regarding first-pass success rate, with 46% in the CA group and 18% in the SO group, (OR 3.83, 95% CI 1.28 to 11.44, p = 0.016). Complete procedure success tended to be more frequent in the CA group than in the SO group—94.6% vs. 84.8% (OR 3.13, 95% CI 0.56 to 17.34, p = 0.193)—and CA tended to require a lower number of passes than SO (mean 1.76 vs. 2.09 passes per procedure, p = 0.114), yet these differences did not reach statistical significance. Mean duration of the procedure was significantly shorter in the CA group than in the SO group (49 min vs. 64 min, p = 0.017). There was a significant difference in clinical outcomes, with higher Δ NIHSS (9.3 in the CA group vs. 6.7 in the SO group, p = 0.025) after the procedure and 90-day mRS (median 2 in the CA group vs. 4 in the SO group, p = 0.031). Conclusions: Combining stent retrievers with aspiration catheters may offer a beneficial effect on angiographic results and clinical outcomes in stroke patients undergoing endovascular treatment.

Abstract 16884: Evaluating the Effectiveness of Atrial Fibrillation Ablation Guided by Spatiotemporal Electrogram Dispersion

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brian Liu ◽  
Arismendy Nunez-Garcia ◽  
Cao Tran ◽  
Michael Wu
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Tachycardia ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
External Validation ◽  
Posterior Wall ◽  
High Rate ◽  
Single Center Experience ◽  
The Mean

Introduction: Catheter ablation of atrial fibrillation (AF) guided by spatiotemporal dispersion (SD) of electrograms has been proposed as an ablation strategy to treat patients with persistent AF. However, external validation of this technique is lacking. Here we report a single center experience using ablation by SD. Hypothesis: Targeting regions with SD is associated with a high rate of termination and favorable freedom from AF among patients with persistent AF. Methods: Patients with persistent AF who underwent SD from November 2018 to January 2020 were included in this study. All patients underwent pulmonary vein isolation (PVI) in addition to targeting areas of SD. Lesions on areas of electrogram dispersion were anchored to the PVI or to mitral or posterior wall lines where appropriate. EKG, Holter, event monitors or device interrogations were obtained at 3 and 6 months to assess for arrhythmia recurrence. Results: 44 patients met the inclusion criteria and were included in the study. The patients had a mean age of 69±8 years and were 68 % male. The prevalence of comorbidities was as follows: hypertension (89%), diabetes (21%), OSA (37%) and CAD (26%). Average CHADSVASC score was 2.9±1.4, LVEF was 53±11% and left atrium (LA) diameter was 5.2±1 cm. The recurrence rate of AF at 6 months was 14% whereas the recurrence of atrial tachycardia was 20%. Acute AF termination was observed in 73% of the patients. Termination to sinus occurred in 38% of the patients and the remaining terminated to atrial tachycardia which was subsequently ablated to sinus. The mean procedure duration was 240±90 minutes. Univariate analysis showed recurrence was associated with LA diameter (r=.52; p<.001). No recurrences were observed among patients with a LA diameter < 5 cm. Termination rates were higher among patients with LA diameter < 5 cm when compared to LA diameter ≥ 5 cm. However, it did not reach statistical significance (80% vs. 60%; p=.21). Conclusions: The target of electrograms with SD during AF ablation added to PVI was associated with a high termination rate and a good freedom from AF recurrence at 6 months. The ideal candidate for this procedure may be those with LA diameter < 5 cm among persistent AF. The long-term efficacy of this technique merits further studies in larger populations.

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