罗库溴铵预注和麻黄碱预处理对小儿罗库溴铵肌松起效的影响

目的 观察小儿在罗库溴铵预注、麻黄碱预处理和罗库溴铵预注复合麻黄碱预处理对罗库溴铵起效时间、插管条件和肌松时效的影响.方法 选择全麻下行择期手术的患儿80例,ASA Ⅰ或Ⅱ级,随机均分为四组.在麻醉诱导前预先静注:Ⅰ组生理盐水O.5 ml,Ⅱ组罗库溴铵0.06 mg/kg,Ⅲ组麻黄碱70 μg/kg,Ⅳ组罗库溴铵0.06 mg/kg和麻黄碱70 μg/kg.预注和预处理4min后,Ⅰ、Ⅲ组静注罗库溴铵0.6 mg/kg,Ⅱ、Ⅳ组静注罗库溴铵0.54 mg/kg.待四个成串刺激(TOF)第1个颤搐反应高度(Th)达最大阻滞程度后行气管插管.记录肌颤搐抑制75%、90%和达最大阻滞程度的时间,并评估气管插管条件,同时观察HR、BP变化.结果 Ⅰ、Ⅱ、Ⅲ、Ⅳ组的最大阻滞起效时间分别为(196±43)、(140±43)、(144±35)和(100±33)s,Ⅱ、Ⅲ、Ⅳ组的起效时间明显短于Ⅰ组(P＜0.05),Ⅳ组的起效时间较Ⅱ、Ⅲ组短(P＜0.05).各组气管插管条件均达到6～9分,优良率100%.各组麻醉诱导期间均无明显的心血管不良反应.各组的临床肌松作用时间和恢复指数差异均无统计学意义.结论 罗库溴铵预注和麻黄碱预处理分别使用均能缩短小儿罗库溴铵的肌松起效时间,而两种方法复合使用可进一步加快肌松起效,但该方法对罗库溴铵的肌松时效无明显的影响.     

罗库溴铵对皱眉肌和拇内收肌肌松作用时效的比较

目的比较皱眉肌(CS)和拇内收肌(AP)在罗库溴铵肌松作用起效时间和恢复过程中的差异。方法40例择期行胆囊切除术或胃大部切除术的患者,随机分为2组,A组:罗库溴铵用量为0.6mg,/kg,B组罗库溴铵用量为0.9mg/kg,每组20例。行硬膜外麻醉后,A、B组分别静脉注射罗库溴铵0.6、0.9mg/kg。用TOF同步刺激,并记录CS和AP肌松起效时间,观察在80%肌颤搐抑制时的气管插管条件,以及恢复过程中T125%恢复时间及恢复指数(RI)。每组10例患者在AP的T1达80%抑制时行气管插管,另10例在CS的T1达80%抑制试行气管插管,分别评定该时的气管插管条件。结果A组AP和CS的最大T1抑制均为100%,AP、CS的起效时间分别为106±34、(111±36)s,B组AP和CS的起效时间分别为84±28、(74±26)s;与A组比较,B组AP和CS的起效时间均缩短(P<0.05)。两组在CS抑制达80%时指导气管插管的总体优良率(20/20)明显高于AP抑制达80%时指导气管插管的总体优良率(12/20)(P<0.01)。B组T125%恢复时间和RI均均长于A组(P<0.05)。两组AP与CS的T125%恢复时间与RI比较差异无统计学意义(P>0.05)。结论罗库溴铵的肌松作用时效在CS和AP有差异,3倍ED95较2倍ED95罗库溴铵的肌松起效时间缩短。CS肌群的肌松监测有助于改善气管插管的条件。     

维族和汉族患者罗库溴铵肌松时效的比较

目的 比较维族和汉族患者罗库溴铵的肌松时效.方法 择期拟在全麻下行甲状腺手术的维吾尔族患者(W组)和汉族患者(H组)各15例,ASA Ⅰ或Ⅱ级,性别不限,年龄20～55岁,体重45～73 kg.静脉注射咪达唑仑、异丙酚、芬太尼和琥珀胆碱行麻醉诱导气管插管后,静脉注射罗库溴铵0.6 mg/kg,采用加速度仪单个刺激模式监测肌松起效时间、无反应期、临床维持时间、75%恢复时间和恢复指数.结果 两组肌松起效时间比较差异无统计学意义(P>0.05);与H组比较,W组无反应期、临床维持时间、75%恢复时间及恢复指数均明显缩短(P<0.05).结论 维吾尔族与汉族患者罗库溴铵的肌松时效存在明显差别,临床上用量需要考虑民族差异的影响.     

罗库溴铵复合麻黄碱预先给药对全麻患者罗库溴铵肌松效应的影响

目的 探讨罗库溴铵复合麻黄碱预先给药对罗库溴铵肌松效应的影响.方法 择期全麻手术患者100例,ASAⅠ或Ⅱ级,年龄23～64岁,体重42～88 kg,身高150～181 cm,随机分为5组(n=20):罗库溴铵组(C组)、罗库溴铵预先给药组(R组)、麻黄碱预先给药组(E组)、罗库溴铵复合麻黄碱预先给药组(RE组)和琥珀酰胆碱组(S组).麻醉诱导前R组、E组和RE组分别静脉注射罗库溴铵0.06 mg/kg、麻黄碱70 μg/kg、罗库溴铵0.06 mg/kg复合麻黄碱70 μg/kg,C组和S组无预先给药.麻醉诱导后4 min时C组和E组静脉注射罗库溴铵0.6 mg/kg,R组和RE组静脉注射罗库溴铵0.54 mg/kg,S组静脉注射琥珀酰胆碱1 mg/kg.采用Cooper法评分标准评定气管插管条件.记录从麻醉诱导时静脉注射罗库溴铵完毕至肌颤搐(Th)降至25%、10%、0的时间(分别为T25、T10、T0)和Th恢复至25%、50%的时间(分别为RT25、RT50)、肌松维持时间(从T0至RT25的时间),麻醉诱导期间每分钟记录1次心率、收缩压、舒张压和平均动脉压.结果 各组气管插管条件差异无统计学意义(P＞0.05);与C组比较,其余4组T25、T10、T0均缩短,S组RT25、RT50缩短(P＜0.05);与RE组和S组比较,R组和E组T0延长(P＜0.05);与S组比较,C组、R组、E组和RE组肌松维持时间延长(P＜0.05).结论 罗库溴铵复合麻黄碱预先给药后罗库溴铵肌松起效时间短于单独预先给药,但对肌松程度和维持时间无明显影响.     

脓毒血症对大鼠罗库溴铵药效学的影响

目的 评价脓毒血症对大鼠罗库溴铵药效学的影响.方法 健康雄性SD大鼠40只,体重250～350 g,采用随机数字表法,将其随机分为对照组(C组,n=10)、假手术组(S组,n=10)和脓毒血症组(Sep组,n=20).Sep组采用盲肠结扎穿孔术制备脓毒血症模型,并于术后6和16 h时分别取10只大鼠,静脉注射罗库溴铵3.81 mg/kg;S组不结扎穿孔盲肠,仅于术后6h静脉注射罗库溴铵3.81 mg/kg.采用RM6240B型多道生理信号采集处理系统记录肌松起效时间、TOF无反应期、高峰时间、临床肌松作用时间、体内肌松作用时间、T1从最大抑制到恢复至10％、25％、50％、75％、90％的时间和恢复指数.结果与C组和S组比较,Sep组罗库溴铵肌松起效时间延长,TOF无反应期、高峰时间、临床肌松作用时间、体内肌松作用时间、T1从最大抑制到恢复至10％、25％、50％、75％、90％的时间和恢复指数缩短(P＜0.05);Sep组术后16 h时注射罗库溴铵较术后6h时注射肌松起效时间延长,T1恢复至75％的时间缩短(P＜0.05).结论 脓毒血症可降低罗库溴铵的肌松效应,其效应与脓毒血症严重程度有关.     

罗库溴铵以限时法和预注法行快速气管插管的比较

目的 比较罗库溴铵以限时法和预注法行快速气管插管的条件、肌松效应及对循环系统的影响。方法 限时（Ⅰ、Ⅱ）组诱导前30秒静注0.6mg/kg罗库溴铵,诱导后45秒（I）、60秒（Ⅱ）行气管内插管,预注（Ⅲ）组诱导前2分钟预注0.06mg/kg罗库溴铵（诱导量0.54mg/kg）,诱导后60秒行气管内插管。记录拇内收肌诱发颤搐反应的抑制和恢复过程,评价各组插管效果。结果气管内插管条件各组间无明显差异;气管内插管时T1抑制百分比Ⅲ组明显小于其他各组;各且对循环系统的都很小。结论 罗库溴铵以限时法行快速气管插管较预注法为佳。     

布依族与汉族患者罗库溴铵肌松时效的比较

目的 比较布依族与汉族患者罗库溴铵的肌松时效.方法 择期全麻下行腔镜或关节镜手术患者60例,性别不限,年龄20 ～ 55岁,体重指数18～25 kg/m,ASA分级Ⅰ或Ⅱ级,按民族分为2组(n=30):汉族组(H组)和布依族组(B组).静脉注射咪达唑仑和芬太尼,靶控输注异丙酚行麻醉诱导.待患者意识消失后进行肌松定标,采用加速度仪单个刺激模式,肌颤搐达最大抑制时静脉注射罗库溴铵0.6 mg/kg,气管插管行机械通气,维持PETCO2 30～35 mm Hg.记录肌松起效时间、无反应期、临床作用时间、75％恢复时间和恢复指数.采用ELISA法测定血浆α1-酸性糖蛋白浓度,采用生化法测定血浆白蛋白浓度.结果 与H组比较,B组肌松起效时间延长,血浆α1-酸性糖蛋白浓度降低(P＜0.05),无反应期、临床作用时间、75％恢复时间、恢复指数和血浆白蛋白浓度差异无统计学意义(P＞0.05).结论 布依族患者较汉族患者罗库溴铵肌松起效慢,可能与布依族患者血浆α1-酸性糖蛋白浓度较低有关.     

罗库溴铵和顺式阿曲库铵用于肝部分切除术肌松效应的比较

目的比较罗库溴铵和顺式阿曲库铵用于肝部分切除术的肌松效应。方法择期全麻下行剖腹单纯肝部分切除术患者40例,随机均分为罗库溴铵组(R组)和顺式阿曲库铵组(C组)。全麻肌松药诱导量R组和C组分别为2倍ED95的罗库溴铵0.6mg/kg及顺式阿曲库铵0.1mg/kg,采用TOF监测肌松程度,当TOFr至25%时追加肌松药。观察两组肌松药起效时间、气管插管条件、临床作用时间、术毕恢复指数、气管拔管时间及不良反应。结果 R组起效时间明显快于、临床作用时间及术毕恢复指数明显长于C组(P0.05);两组气管拔管时间差异无统计学意义。当TOFr为0时,R组气管插管条件为优的例数明显多于C组(P0.05)。R组静脉注射痛发生率为16例(80%),明显高于C组的3例(15%)(P0.05)。两组患者围术期均未发生皮肤潮红、BP降低、HR增快及支气管痉挛等不良反应,未观察到拔管后的肌松残余作用。结论与顺式阿曲库铵比较,应用罗库溴铵具有起效快,作用时间长,虽恢复指数略长,但对拔管时间并无影响,同时未有明显的肌松残余作用,可以安全用于肝部分切除术的患者。     

肝移植术患者罗库溴铵不同给药方式肌松效果的比较

目的 比较肝移植术患者间断静脉注射(Ⅳ)、静脉输注(CI)和靶控输注(TCI)罗库溴铵的肌松效果.方法 拟行肝移植术的患者36例,性别不限,年龄21～63岁,体重48～80 kg,Child-Pugh评分7～9分,肝功能Child分级B或C级,随机分为3组(n=12):Ⅳ组、CI组和TCI组.采用TOF模式进行肌松监测,Ⅳ组:麻醉诱导时静脉注射罗库溴铵0.6 mg/kg,无肝前期T1恢复至25%时、无肝期和新肝期T4/T1(TOFR)恢复至25%时追加0.15 mg/kg.TCI组:麻醉诱导时靶控输注罗库溴铵,初始效应室靶浓度3μg/ml,调整靶浓度,维持T1 5%～10%;无肝期和新肝期开始时暂停TCI,随后以效应室靶浓度0.1μg/ml再次输注,调整靶浓度,维持T15%～10%.CI组:麻醉诱导时静脉注射罗库溴铵0.6 mg/kg,无肝前期以30μg·kg-1·min-1的速率开始静脉输注,调节输注速率,维持T1 5%～10%,无肝期和新肝期开始时暂停CI,随后以1μg·kg-1·min-1的速率静脉再次输注,调整输注速率,维持T15%～10%.各组于肌松达最大效应时行气管插管,于缝合腹膜后停止给药.记录麻醉诱导时罗库溴铵肌松起效时间、T1最大抑制程度和气管插管条件满意情况;记录各组无肝期T1 25%恢复时间及TOFR 25%恢复时间,新肝期停药后T125%恢复时间、TOFR 25%恢复时间、TOFR 75%恢复时间、TOFR90%恢复时间及恢复指数;记录罗库溴铵总用量.结果 与Ⅳ组比较,TCI组和CI组气管插管条件满意率、罗库溴铵总用量、麻醉诱导时罗库溴铵起效时间、T1最大抑制程度和各期肌松恢复情况差异均无统计学意义(P＞0.05).肌松效应监测图显示Ⅳ组各期罗库溴铵肌松效应波动较大,TCI组和CI组各期肌松效应较为平稳.结论 采用Ⅳ、CI和TCI给药时,肝移植术患者罗库溴铵肌松起效和恢复情况无差异,而采用TCI或CI给药时,肌松效应较Ⅳ更加平稳.     

肌松监测下罗库溴铵气管插管时机的临床研究

目的 比较肌松监测下静脉注射罗库溴铵0.9mg/kg后60秒和4个成串刺激(train-of-four,TOF)的T1达到最大抑制程度时的气管插管条件,探讨该药理想的气管插管时机.方法 120例行择期腹腔镜胆囊切除术患者,年龄18岁～60岁,ASA Ⅰ-Ⅱ级,随机均分为两组.分别于静脉注射罗库溴铵0.9 mg/kg后60秒(A组)或T1达到最大抑制程度时(B组)行气管插管.观察并记录两组罗库溴铵起效时间(TOF的T1达到最大抑制程度的时间)、气管插管条件(Cooper's评分)、声门暴露程度(Cormack-Lehane分级)、诱导过程中的心率(heart rate,HR)和收缩压(systolic blood pressuref,SBP)变化以及术后24 h咽喉并发症(喉痛、声嘶等不适).结果 静注罗库溴铵0.9 mg/kg后66.0秒±18.1秒(95%可信区间30.2秒一101.8秒)达到T1最大抑制.B组Cooper's评分和Cormack-Lehane分级均优于A组(P相似文献   

Dexmedetomidine reduces pain associated with rocuronium injection without causing a decrease in BIS values: a dose-response study

Study ObjectivesTo examine whether dexmedetomidine reduces the injection pain of propofol and rocuronium and to investigate whether the decrease in injection pain is associated with the known sedative action of dexmedetomidine.DesignRandomized, double-blind, placebo-controlled clinical comparison study.InterventionsPatients undergoing general anesthesia with intubation received 40 mg of 1% lidocaine (lidocaine group; n = 28), 0.25 μg/kg of dexmedetomidine (low-dose group; n = 27), 0.5 μg/kg of dexmedetomidine (subclinical dose group; n = 28), 1.0 μg/kg of dexmedetomidine (clinical dose group, n = 27), or normal saline (saline group; n = 28) before anesthetic induction.MeasurementsPain associated with propofol and rocuronium injection was assessed using a 10-point verbal analog scale (VAS) and a 4-point withdrawal movement scale, respectively. The BIS value was measured 60 seconds after administration of the study drug, and at the time of rocuronium injection and intubation.Main ResultsThe overall incidence of withdrawal movements due to rocuronium decreased significantly as the dose of dexmedetomidine increased (92.8%, 85.2%, 78.6%, and 51.9% in the saline, low-dose, subclinical dose, and clinical dose groups, respectively; P = 0.001). There was no significant difference in BIS values among the groups 60 seconds after study drug administration or at the time of rocuronium injection.ConclusionsDexmedetomidine reduced pain associated with rocuronium injection in a dose-dependent manner. This effect was not associated with the decrease in BIS value.     

Rocuronium-induced withdrawal movements associated with different Rocuronium injection method

Objectives: One hundred and twenty patients (3–15 years old) were randomly enrolled (four groups: each group = 30 patients) in the study. Aim: The aim of this study was to compare the incidence and intensity of rocuronium‐induced withdrawal movements in children injected with a typical intravenous bolus injection of rocuronium or with an infusion injection of rocuronium. Background: Intravenous bolus injection of rocuronium produces pain and withdrawal movement. Methods: Immediately after loss of consciousness by thiopental sodium (5 mg·kg^?1), 0.6 mg·kg^?1 (B0.6, I0.6) or 0.9 mg·kg^?1 rocuronium (B0.9, I0.9) was injected by different method, either a bolus injection over 5 s (B0.6, B0.9) or an infusion injection lasting for 1 min (I0.6, I0.9). The withdrawal movement of the patients to the injection of rocuronium was assessed (four‐grade score: 0–3). Intubating condition was assessed. Rocuronium‐induced muscle relaxation time was measured by single twitch stimulation fade out. Results: The incidence (group B: 100%, group I: 33.3%) and the intensity of the withdrawal movements were significantly lower in the infusion groups compared with the bolus groups (P < 0.05). The intubating conditions for all groups were clinically acceptable (good to excellent). There was no significant difference in the muscle relaxation time between the different injection groups (I0.6; 105.6 ± 7.7 vs B0.6; 114.6 ± 8.0, I0.9; 69.2 ± 3.6 vs B0.9; 73.4 ± 1/0). Conclusions: The infusion injection of rocuronium for tracheal intubation significantly reduced the incidence and intensity of withdrawal movement on injection of rocuronium, and it neither delays the onset of muscle relaxation nor deteriorates the intubating condition.     

Cisatracurium or rocuronium versus rocuronium-cisatracurium combination

The present report evaluates the incidence of pain on intravenous injection and the condition of tracheal intubation at one minute following the administration of cisatracurium or rocuronium versus rocuronium-cisatracurium combination. We studied 60 patients, ASA 1, aged 18-60 years, undergoing elective surgical procedures. The patients were randomly assigned to 3 groups who received intravenously either 0.15 mg/kg cisatracurium [2ED95], 0,6 mg rocuronium [2ED95] or a combination of 0.075 mg/kg cisatracurium [1ED95], plus 0.3 mg rocuronium [1ED95]. In the awake patients, the pain on injection of muscle relaxant was assessed on a four point scale (none, mild, moderate, severe). Administration of the relaxant was followed by 1-2 mg/kg of lidocaine and 2 mg/kg propofol. Orotracheal intubation was performed 60 seconds following the administration of the relaxant. The intubating conditions were assessed and rated as excellent, good, fair or poor. The administration of 2ED95 cisatracurium resulted in poor intubating conditions at 60s, without pain on injection. In contrast, the administration of 2ED95 rocuronium resulted in excellent or good intubating conditions at 60s associated with high incidence of pain on injection in most of the patients. However, the combination of 1ED95 cisatracurium with 1ED95 rocuronium provided similar intubating conditions to the 2ED95 rocuronium alone, associated with a significantly less pain on injection.     

Prevention of withdrawal associated with the injection of rocuronium in adults and children

STUDY OBJECTIVE: To determine which technique prevents the withdrawal associated with rocuronium administration in adults and children. DESIGN: Blinded, randomized, prospective trial. SETTING: This study was set at an inpatient anesthesia in a university teaching hospital. PATIENTS: 200 adult patients (aged 19-63 years) and 150 children (aged 2-9 years) undergoing elective surgery requiring endotracheal intubation. INTERVENTIONS: Four groups in adult and 3 groups in children of 50 patients each were investigated. In adult study, control groups with free intravenous (IV) flow (C-F) or the occlusion of IV flow (C-O) received saline as the pretreatment of rocuronium; lidocaine groups with free IV flow (L-F) or the occlusion of IV flow (L-O) received lidocaine as the pretreatment of rocuronium, preceded by thiopental 5 seconds before. In children study, groups P and L received saline and lidocaine as the pretreatment of rocuronium, respectively, and group S received rocuronium mixed with sodium bicarbonate after the pretreatment of placebo preceded by thiopental. MEASUREMENTS AND MAIN RESULTS: The patient's response to rocuronium injection was graded using a 4-point scale. The pH and osmolality of treatment solution were measured. The incidence of no movement after rocuronium was 96% in L-O, 46% in L-F, 26% in C-O, and 18% in C-F in adult and 96% in S, 58% in L, and 8% in P in children. CONCLUSIONS: Withdrawal after rocuronium can be eliminated by the pretreatment of lidocaine during the occlusion of the IV flow in adults and addition of sodium bicarbonate in children.     

Effect of narcotic pretreatment on pain after rocuronium injection: a randomized,double-blind controlled comparison with lidocaine

Various strategies have been studied to reduce the discomfort of rocuronium pain. These studies have shown fentanyl and lidocaine to be effective in reducing the incidence of pain on rocuronium injection. This prospective, randomized, and double-blind study was carried out on 80 neurosurgical patients for whom pain on rocuronium injection was assessed after pretreatment with lidocaine, fentanyl, sufentanil, or normal saline. The 80 neurosurgical patients were randomly allocated to anyone of the groups to receive lidocaine, fentanyl, sufentanil, or normal saline prior to being given rocuronium. The patients were asked about any discomfort in the hand, and also to rank that discomfort on a 5-point scale. In the normal saline group, the incidence of pain was 95%, of which 90% had very severe pain. In the lidocaine group, only 10% of patients reported pain, which was mild in nature. In the fentanyl group, 95% of patients had pain, of whom 25% had severe to very severe pain. In the sufentanil group, 85% of patients reported pain, of whom 25% fell into the severe to very severe group. We found that lidocaine was best at decreasing the incidence of pain on intravenous (i.v.) injection of rocuronium. Although the incidence of pain on injection of rocuronium with both fentanyl and sufentanil was high, the intensity was definitely reduced, with most patients falling in the mild pain group.     

Comparison of rocuronium and vecuronium in paediatric cardiac surgery, using sevoflurane anaesthesia

Aim. The goal was to study the haemodynamic effects and intubating conditions, of rocuronium, vs. vecuronium in paediatric patients undergoing elective cardiac surgery. The haemodymanic effects and intubating conditions, of rocuronium, in children undergoing cardiac surgery, remain incompletely characterised. Methods. A double blind randomised study was conducted in 40 children with congenital heart disease, undergoing open heart surgery. Patients were divided into 2 groups — Group A received rocuronium (0.9 mgkg⁻¹) and Group B, vecuronium (0.2 mgkg⁻¹) (n=20 in each group) Intubating conditions and haemodynamic profile were assessed at 60 seconds and at 90 seconds. Neuromuscular monitoring was established before muscle relaxant administration. Anaesthesia technique standardised with sevoflurane 7–8% in addition, was used in both groups. Results. Compared with vecuronium, rocuronium was associated with shorter onset time (60.2±20.2 vs 88.6±41.2 secs; P<0.001) and clinical duration of action (34.3±8.4 vs 44.7±6.2 min, P<0.001). According to standardised, intubation scores, intubation conditions, at 90 seconds in Group A was 90% and Group B 80%. However at 60 seconds they were 80% and 40% respectively. Haemodynamic stability in both the groups was similar, although one patient in Group B showed transient bradycardia and hypotension. Conclusion. Rocuronium showed better intubating conditions than vecuronium at 60 seconds in paediatric patients undergoing open heart surgery.     

Intubation conditions following rocuronium: influence of induction agent and priming

A small priming dose of rocuronium can shorten the onset time of neuromuscular blockade. Induction agents with less cardiovascular depression also reduce the onset time. We hypothesized that ketamine, compared to thiopentone, would reduce onset time and improve intubating conditions following priming. Sixty patients ASA I to II, randomized by computer-generated sequence to four groups were investigated in a double-blind controlled trial. In the two groups with priming, 0.04 mg/kg of rocuronium was followed by three minutes of priming interval. Induction was followed by an intubation dose of 0.4 mg/kg of rocuronium. After 30 seconds, intubation was attempted within a further 20 seconds. In the two control groups, the same sequence was repeated except sham priming (saline) was given. For induction, S-ketamine (1 mg/kg) or thiopentone (4 mg/kg) were administered. Intubating conditions were graded as excellent, good, poor, or not possible. Neuromuscular transmission was monitored by acceleromyography of the thumb. There were no measured differences in onset time of neuromuscular block or in haemodynamics between the groups. The proportion of good to excellent intubating conditions was higher when ketamine was preceded by priming compared to ketamine without priming (87% vs 20%; P<0.05). In both priming and control groups intubating conditions were improved when using ketamine compared to thiopentone (P<0.05). The mechanism of this effect was not clear from this study.     

Rapid injection of rocuronium reduces withdrawal movement on injection

Study ObjectiveTo test whether rapid injection of rocuronium reduces withdrawal movement on injection.DesignRandomized, prospective trial.SettingOperating room in a university hospital.Patients150 ASA physical status I and II patients aged 18 to 60 years, undergoing general anesthesia.InterventionsPatients were randomized to three groups. After undergoing anesthesia induction with thiopental sodium, then 5 seconds later receiving a rubber tourniquet applied to the mid-forearm to stop intravenous (IV) flow by gravity, the pretreatment drug was injected. The tourniquet was held for 15 seconds then released, and 1.0 mg/kg of 1% rocuronium was injected IV. Group C patients (n = 50) were pretreated with 0.1 mL/kg of 0.9% NaCl and then injected with rocuronium slowly within 10 seconds. Group L patients (n = 50) were pretreated with 0.1 mL/kg of preservative-free 1% lidocaine and then injected with rocuronium slowly within 10 seconds. Group R patients (n = 50) were pretreated with 0.1 mL/kg of 0.9% NaCl and then rapidly injected with rocuronium within approximately one second (as quickly as possible).MeasurementsAfter injection of the patient with the study drug, a single anesthesiologist with no knowledge of the study protocol graded each patient's response as follows: 0 = no response; 1 = mild movement limited to the wrist only; 2 = moderate movement involving the elbow and shoulder; and 3 = severe movement involving more than one extremity.Main ResultsGroup C had the most intense and frequent withdrawal response. The frequency and intensity of withdrawal movement was significantly less in Groups L and R than Group C. No significant difference in withdrawal response between Groups L and R was noted.ConclusionsWithdrawal response can be significantly reduced for rocuronium injection without lidocaine pretreatment, simply through rapid injection.     

Dilution of rocuronium to 0.5 mg/mL with 0.9% NaCl eliminates the pain during intravenous injection in awake patients

In a randomized, double-blinded, controlled study, we evaluated the effect of diluting rocuronium 10 mg/mL to 1 or 0.5 mg/mL with 0.9% NaCl on the pain associated with IV administration of rocuronium with small doses given before succinylcholine or nondepolarizing agent administration. One hundred fifty patients undergoing surgical procedures that required general anesthesia were randomized into three groups. Group 1 received rocuronium 10 mg/mL. Groups 2 and 3 received 1 and 0.5 mg/mL of rocuronium, respectively. Patient demographics, pain scores, osmolality, and the pH of the solutions were recorded. Group 1 had the most intense and frequent pain response. Eighty percent of patients in this group reported pain on injection. In Group 2, the incidence and intensity of pain were significantly less when compared with those of Group 1. In this group, 38% of patients reported pain during injection. In Group 3, none of the patients experienced pain on injection. The pH values and osmolalities of study solutions were not significantly different among groups. In conclusion, in awake patients, dilution of rocuronium 10 mg/mL at small doses given before succinylcholine or nondepolarizing agent administration of 0.06 mg/kg to 0.5 mg/mL with 0.9% NaCl is a simple and cost-effective strategy for preventing pain during IV rocuronium injection.