A comparison of acceleromyography and mechanomyography for determination of the dose–response curve of rocuronium in children

In order to compare an acceleromyograph (TOF-Guard^TM) with a mechanomyograph (Grass FT03), the dose–response relationship of rocuronium was simultaneously determined in both arms of 15 children aged 3–11 years during anaesthesia with thiopentone, alfentanil and nitrous oxide. Three subgroups of five children received rocuronium 120, 180 or 240 μg.kg⁻¹ randomly. The effective doses to produce 50% and 95% depression of the first twitch of the train-of-four determined by acceleromyography were 206 and 337 μg.kg⁻¹, respectively, while these values determined by mechanomyography were 151 and 331 μg.kg⁻¹, respectively. The dose–response curve obtained by acceleromyography was steeper and shifted to the right compared with that obtained by mechanomyography (p < 0.0001). The difference between the effective dose producing 50% twitch depression determined by the two devices was highly significant (p < 0.0001). In 13 out of 15 children, the acceleromyograph control train-of-four ratio was significantly greater than unity. Although there was a good correlation ( r  = 0.85) between simultaneous pairs of measurements of neuromuscular block, the acceleromyograph exhibited a bias of −25% relative to the mechanomyograph with wide limits of agreement (−62 to +12%). We conclude that acceleromyographic and mechanomyographic measurements should not be used interchangeably when determining the potency of muscle relaxants.     

罗库溴铵、阿曲库铵和琥珀酰胆碱三药肌松作用的对照研究

全麻下组Ⅰ以罗库溴铵０ ．６ ｍｇ／ｋｇ 静注,组Ⅱ以阿曲库铵０ ．５ ｍｇ／ｋｇ 静注,组Ⅲ以琥珀酰胆碱１ ．５ ｍｇ／ｋｇ 静注。结果：气管插管条件,以琥珀酰胆碱组肌松作用最好,而罗库溴铵和阿曲库铵肌松作用相似;罗库溴铵组肌松起效时间、临床恢复时间和无反应时间分别为８６ ．２５ ±２７ ．１３ｓ 、２９ ．９０ ±６ ．２５ ｍｉｎ 和２０ ．８４ ±７ ．９５ ｍｉｎ ,介于其它两药之间。说明,罗库溴铵可为临床提供较好的气管插管条件,且无琥珀酰胆碱的诸多副作用。     

Continuous infusion of rocuronium in a paediatric intensive care unit

Purpose  

To evaluate prospectively the efficacy and dose requirements of rocuronium administered by continuous infusion for neuromuscular blockade in a paediatric ICU population.     

Effects of vecuronium and rocuronium in antagonistic laryngeal muscles and the anterior tibial muscle in the cat

BACKGROUND: Adequate vocal cord paralysis and full recovery of laryngeal muscle function are important when muscle relaxants are used perioperatively. This study was designed to compare the effects of vecuronium and rocuronium at the vocal cord abductor and adductor muscles and the anterior tibial muscle in cats. METHODS: Twelve adult cats were studied under pentobarbitone-N2O/O2-anesthesia. After supramaximal electrical stimulation of the peroneal nerve and the recurrent laryngeal nerve (0.1 Hz and intermittent train-of-four) evoked electromyographic responses were obtained from the anterior tibial muscle, the posterior cricoarytenoid muscle (vocal cord abductor) and two vocal cord adductor muscles, the lateral cricoarytenoid and the vocal muscle. Six cats received bolus doses of increasing size of vecuronium (ED90 22.5 microg x kg(-1)) and six cats rocuronium (ED90 90 microg x kg(-1)). RESULTS: Equipotent doses of vecuronium and rocuronium caused a similar degree of paralysis in all muscles (vecuronium ED90: 70% blockade at the posterior cricoarytenoid, 83% at the lateral cricoarytenoid, 84% at the vocal muscle and 90% at the anterior tibial muscle; rocuronium ED90: 71% at the posterior cricoarytenoid, 67% at the lateral cricoarytenoid, 78% at the vocal muscle and 90% at the anterior tibial muscle; vecuronium 2 x ED90: 93% blockade at the posterior cricoarytenoid, 95% at the lateral cricoarytenoid, 97% at the vocal muscle and 99% at the anterior tibial muscle; rocuronium 2 x ED90: 89% blockade at the posterior and lateral cricoarytenoid, 93% at the vocal muscle and 100% at the anterior tibial muscle). Onset time was significantly shorter at the posterior cricoarytenoid muscle (290 s) compared to the lateral cricoarytenoid muscle (400 s) after vecuronium ED90 and to the vocal muscle (150 s versus 210 s) after rocuronium ED90. Compared to the anterior tibial muscle (interval 25-75%: 6.5 min after vecuronium 2 x ED90 and 3.3 min after rocuronium 2 x ED90 and to the posterior cricoarytenoid muscle (interval 25-75%: 7 min after vecuronium 2 x ED90 and 4.3 min after rocuronium 2 x ED90), recovery of laryngeal adductor muscle function was markedly delayed with both neuromuscular blocking drugs (interval 25-75% at the lateral cricoarytenoid and vocal muscle: 14 min and 15.8 min after vecuronium 2 x ED90 and 10.3 min and 11.6 min after rocuronium 2 x ED90 respectively). CONCLUSION: In cats, the time course of neuromuscular blockade after vecuronium and rocuronium differs in antagonistic laryngeal muscles. The protective laryngeal function of glottis closure recovers later than vocal cord abduction after both vecuronium and rocuronium.     

Retrospective observational study of the effects of residual neuromuscular blockade and sugammadex on motor-evoked potential monitoring during spine surgery in Japan

Given neuromuscular blockade (NMB) can affect the amplitude and detection success rate of motor-evoked potentials (MEP), sugammadex may be administered intraoperatively. We evaluated the factors affecting the degree of residual NMB (i.e., the train-of-four [TOF] ratio) and the relationship between TOF ratio and MEP detection success rate in Japanese patients undergoing spine surgery. This single-center retrospective observational study included adults who underwent spine surgery under propofol/remifentanil anesthesia, received rocuronium for intubation, and underwent myogenic MEP monitoring after transcranial stimulation. TOF ratios were assessed using electromyography. Sugammadex was administered after finishing the MEP setting and the TOF ratio was ≤0.7. To identify factors affecting the TOF ratio, TOF ratio and MEP detection success rate were simultaneously measured after finishing the MEP setting; to compare the time from intubation to the start of MEP monitoring after NMB recovery between sugammadex and spontaneous recovery groups, multivariable analyses were performed. Of 373 cases analyzed, sugammadex was administered to 221 (59.2%) cases. Age, blood pressure, hepatic impairment, and rocuronium dose were the main factors affecting the TOF ratio. Patients with higher TOF ratios (≥0.75) had higher MEP detection success rates. The time from intubation to the start of MEP monitoring after NMB recovery was significantly shorter in patients administered sugammadex versus patients without sugammadex (P < .0001). The MEP detection success rate was higher in patients with a TOF ratio of ≥0.75. Sugammadex shortened the time from intubation to the start of MEP monitoring after NMB recovery.     

年龄对女性患者罗库溴铵气管插管半数有效剂量的影响

目的 通过序贯实验法测定不同年龄女性患者罗库溴铵气管插管的半数有效剂量(IED50),并探讨年龄因素对罗库溴铵IED50的影响.方法 选择ASA Ⅰ～Ⅱ级,择期全麻手术女性患者40例,分为中青年组和老年组,每组20例.将气管插管剂量按等比级数分成4个阶梯,中青年组为0.24、0.29、0.35和0.42 mg/kg,老年组为0.22、0.26、0.31和0.37mg/kg.按照序贯实验方法单次静注罗库溴铵,并计算罗库溴铵气管插管的IED50和95%可信区间(95%CI). 结果 中青年组IED50为0.312 mg/kg,老年组IED50为0.284 mg/kg,老年组的IED50是中青年组的91%(P<0.05).结论 老年女性患者气管插管罗库溴铵IED50显著低于中青年女性患者,使用罗库溴铵麻醉诱导时,应适当减少剂量.     

Efficacy of different doses of sugammadex after continuous infusion of rocuronium

AIM: To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuroniuminduced neuromuscular blockade(NMB).METHODS: Patients between 20 and 65 years of age, with American Society of Anesthesiologists physical status classification Ⅰ-Ⅱ, undergoing gynecological surgery were included in a prospective, comparative and randomized study. NMB was induced with an injection of 0.6 mg/kg of rocuronium followed by continuous infusion of 0.3-0.6 mg/kg per hour to maintain a deep block. Anesthesia was maintained with sevofluorane and remifentanil. Finally, when surgery was finished, a bolus of 2 mg/kg(group A) or 4 mg/kg(group B) of sugammadex was applied when the NMB first response in the train-of-four was reached. The primary clinical endpoint was time to recovery to a train-of-four ratio of 0.9. Other variables recorded were the time until recovery of train-of-four ratio of 0.7, 0.8, hemodynamic variables(arterial blood pressure and heart rate at baseline, starting sugammadex, and minutes 2, 5 and 10) and adverse events were presented after one hour in the post-anesthesia care unit.RESULTS: Thirty-two patients were included in the study: 16 patients in group A and 16 patients in group B. Only 14 patients each group were recorded because arterial pressure values were lost in two patients from each group in minute 10. The two groups were comparable. Median recovery time from starting of sugammadex administration to a train-of-four ratio of 0.9 in group A and B was 129 and 110 s, respectively.The estimated difference in recovery time between groups was 24 s(95%CI: 0 to 45 s, Hodges-Lehmann estimator), entirely within the predefined equivalence interval. Times to recovery to train-of-four ratios of 0.8(group A: 101 s; group B: 82.5 s) and 0.7(group A: 90 s; group B: 65 s) from start of sugammadex administration were not equivalent between groups. There was not a significant variation in the arterial pressure and heart rate values between the two groups and none of the patients showed any clinical evidence of residual or recurrent NMB. CONCLUSION: A dose of 2 mg/kg of sugammadex after continuous rocuronium infusion is enough to reverse the NMB when first response in the Train-OfFour is reached.     

不同神经肌肉阻滞(NMB)深度对腹腔镜结直肠手术手术条件、围术期肺氧合功能及术后肺部并发症的影响

目的 探讨不同神经肌肉阻滞（neuromuscular blockade,NMB）深度对腹腔镜结直肠手术的手术条件、围术期肺氧合功能及术后肺部并发症的影响。方法 以76名腹腔镜结直肠手术患者作为研究对象,其肌肉阻滞程度通过TOF-Watch SX进行监测。将76名患者随机均分为A、B两组,其中A组为深度NMB组,麻醉诱导时采用罗库溴铵（0.6 mg/kg）,术中维持强直刺激后单刺激计数（post-tetanic count,PTC）为1~2;B组为中度NMB组,诱导时采用罗库溴铵（0.6 mg/kg）维持4个成串刺激（train-of-four response,TOF）值为1~2。麻醉诱导采用丙泊酚靶控（效应室靶浓度Ce为2.5 μg/mL）复合瑞芬太尼（0.2 μg·kg^-1·min^-1）输注及舒芬太尼0.3~0.4 μg/kg。术中维持麻醉深度指数（narcotrend index,NTI）为27~46。术毕两组患者均静脉注射舒更葡糖纳拮抗。观察比较两组患者的整体手术条件评分、术中气腹压（intra-abdominal pressure,IAP）、呼吸和心血管参数、围术期氧合指数（oxygenation index,OI）、动态肺顺应性（dynamic lung compliance,Cdyn）、术后疼痛、胃肠道排气时间、术后肺部并发症（postoperative pulmonary complications,PPCs）和30天内再住院率等。结果 相较于B组,A组联合术毕舒更葡糖钠拮抗能够增加整体手术状况评分（P<0.01）,降低术中平均IAP（P<0.01）,缩短术后胃肠道通气时间（P<0.05）,降低术后腹部疼痛评分（P<0.05）,增加围术期OI（P<0.05）及术中Cdyn（P<0.05）,降低PPCs（P<0.05）。两组在苏醒室时间、术后住院时间、30天内再住院率等方面差异无统计学意义（P>0.05）。结论 深度神经肌肉阻滞可以改善手术条件及围术期肺氧合功能,减少手术后PPCs,还可降低术中IAP和减少手术后腹部疼痛,促进术后胃肠道功能恢复,为临床推广使用深度NMB进行腹腔镜结直肠手术提供了理论依据。     

The presumed central nervous system effects of rocuronium in a neonate and its reversal with sugammadex

We describe a 2‐day‐old male infant who received rocuronium as part of general anesthesia for a tracheal esophageal fistula repair. Postoperatively, he had prolonged central and peripheral neuromuscular blockade despite cessation of the rocuronium infusion several hours previously. This case discusses the presumed central nervous system effects of rocuronium in a neonate and its effective reversal with sugammadex.     

颅脑外科手术中过度通气对罗库溴铵肌松时效的影响

目的:研究过度通气对罗库溴铵肌松时效的影响。方法:选择无神经肌肉疾患、ASAI-Ⅱ级、择期行颅脑外科手术患者40例,随机分成对照组(A组,n=20)和过度通气组(B组,n=20)。术中控制呼吸,维持PaCO2分别大于(A组)或小于(B组)35mmHg。用加速度仪监测拇内收肌收缩反应,观察两组罗库溴铵0.6mg/kg的肌松时效差异。结果:A、B两组起效时间分别为1.26±0.31min和1.18±0.37min,无显著差异;临床时效分别为37.4±7.1min和30.3±6.5min,P<0.05,恢复指数分别为10.4±1.9min和9.2±2.1min,无显著差异。结论:过度通气可使罗库溴铵临床时效缩短,但起效时间和恢复指数无明显差异。