rocuronium and Apnea

The present study was designed to compare the intubating conditions of rocuronium giving by "a modified timing principle" in rapid induction and intubation (RSII) with that of the gold standard, succinylcholine. One hundred and twenty-four patients were randomly divided into rocuronium group (group R, n = 62) or succinylcholine group (group S, n = 62). In group R, after rocuronium 0.6 mg kg

Topics: Androstanols; Apnea; Humans; Intubation, Intratracheal; Neuromuscular Nondepolarizing Agents; Propofol; Rapid Sequence Induction and Intubation; Remifentanil; Rocuronium; Succinylcholine

To identify the dose of rocuronium that will prevent a laryngeal response to water spraying of the glottis in anesthetized cats.. Randomized crossover study.. Eight healthy, adult, short-haired cats, aged 1-4 years, weighing 3.2-6.0 kg.. Each cat was anesthetized four times and administered one of four doses of rocuronium (0.1, 0.2, 0.3 and 0.6 mg kg(-1) ) in random order. The larynx was observed with a video-endoscope inserted through a laryngeal mask airway. Video-clips of the laryngeal response to a sterile water spray (0.2 mL) were obtained at baseline (without rocuronium) and at maximal effect of each treatment. Glottal closure score (0-2), duration of glottal closure, and number of adductive arytenoid movements were obtained from video-clips of laryngeal responses (reproduced in slow motion) at baseline and after treatment. Two observers blinded to treatment allocation scored the vigor of the laryngeal response on a visual analog scale (VAS). The duration of apnea (up to 5 minutes) was recorded for each treatment.. Compared with baseline, rocuronium 0.3 mg kg(-1) and 0.6 mg kg(-1) significantly decreased all glottal scores obtained from the videos (all p < 0.03). Both observers gave lower VAS scores after 0.3 mg kg(-1) (both p = 0.015). Apnea lasting ≥ 5 minutes occurred in none, one, three and seven of eight cats administered doses of rocuronium 0.1, 0.2, 0.3 and 0.6 mg kg(-1) , respectively.. Rocuronium 0.3 mg kg(-1) and 0.6 mg kg(-1) consistently decreased the completeness and duration of the laryngeal response to water spray, and reduced the number of arytenoid adductive movements in response to that stimulus. However, a laryngeal response was never completely prevented. Rocuronium 0.3 mg kg(-1) may be useful for facilitating tracheal intubation. Positive pressure ventilation must be available for cats administered rocuronium.

Topics: Androstanols; Animals; Apnea; Cat Diseases; Cats; Cross-Over Studies; Dose-Response Relationship, Drug; Female; Glottis; Laryngismus; Male; Neuromuscular Nondepolarizing Agents; Physical Stimulation; Rocuronium

Rapid sequence induction may be associated with hypoxemia. The purpose of this study was to investigate the possible difference in desaturation during rapid sequence induction in overweight patients using either succinylcholine or rocuronium.. Sixty patients with a body mass index (BMI) between 25 and 30 kg/m², American Society of Anesthesiologists class I or II, undergoing general anesthesia were randomly divided into a succinylcholine group and a rocuronium group. After a 3-min preoxygenation, patients received rapid sequence induction of general anesthesia with midazolum-fentanyl-propofol and succinylcholine (1.5 mg/kg) or rocuronium (0.9 mg/kg). Ventilation was not initiated until oxygen saturation declined to 92%. We measured the times when oxygen saturation reached 98%, 96%, 94% and 92%. Safe Apnea Time was defined as the time from administration of neuromuscular blocking drugs to oxygen saturation fell to 92%. The recovery period was defined as the time from initiation of ventilation until oxygen saturation was 97%. Arterial blood gases were taken at baseline, after preoxygenation and at 92% oxygen saturation.. The mean Safe Apnea Time (95% CI) was 283 (257-309) s in succinylcholine vs. 329 (303-356) s in rocuronium (P=0.01). The mean recovery period (95% CI) was 43 (39-48) s in succinylcholine vs. 36 (33-38) s in rocuronium (P=0.002). Blood gas analysis showed no difference between the two groups.. Succinylcholine was associated with a significantly more rapid desaturation and longer recovery of oxygen saturation than rocuronium during rapid sequence induction in overweight patients.

Topics: Adult; Androstanols; Anesthesia, General; Apnea; Blood Gas Analysis; Body Mass Index; Endpoint Determination; Female; Humans; Hypnotics and Sedatives; Male; Midazolam; Middle Aged; Monitoring, Intraoperative; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Overweight; Oxygen; Prospective Studies; Rocuronium; Succinylcholine; Young Adult

This study investigates the effect of suxamethonium vs rocuronium on the onset of haemoglobin desaturation during apnoea, following rapid sequence induction of anaesthesia. Sixty patients were randomly allocated to one of three groups. Anaesthesia was induced with lidocaine 1.5 mg.kg(-1), fentanyl 2 microg.kg(-1) and propofol 2 mg.kg(-1), followed by either rocuronium 1 mg.kg(-1) (Group R) or suxamethonium 1.5 mg.kg(-1) (Group S). The third group received propofol 2 mg.kg(-1) and suxamethonium 1.5 mg.kg(-1) only (Group SO). The median (IQR [range]) time to reach S(p)O(2) of 95% was significantly shorter in Group S (358 (311-373 [245-430]) s) [corrected] than in Group R (378 (370-393 [366-420]) s; p = 0.003), and shorter in Group SO (242 (225-258 [189-270]) s) [corrected] than in both Group R (p < 0.001) and Group S (p < 0.001). When suxamethonium is administered for rapid sequence induction of anaesthesia, a faster onset of oxygen desaturation is observed during the subsequent apnoea compared with rocuronium. However, time to desaturation is prolonged whenever lidocaine and fentanyl precede suxamethonium.

Topics: Adult; Androstanols; Anesthesia, General; Anesthetics, Intravenous; Anesthetics, Local; Apnea; Fasciculation; Female; Fentanyl; Humans; Intubation, Intratracheal; Lidocaine; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Oxygen; Rocuronium; Succinylcholine; Young Adult

To evaluate the time to hemoglobin oxygen desaturation in chickens (Gallus gallus domesticus) with and without preoxygenation before isoflurane induction of anesthesia and rocuronium-induced apnea.. Prospective, randomized crossover study.. A total of 10 healthy adult Lohmann Brown-Lite hens.. Hens were anesthetized with isoflurane for intravenous (IV) and intraarterial catheter placement and allowed to fully recover from anesthesia. Hens in the preoxygenation treatment were administered oxygen (2 L minute. Time from start of apnea until hemoglobin desaturation was not significantly different between preoxygenated and nonpreoxygenated hens [26.5 (16-50) seconds and 24.0 (5-57) seconds, respectively; p = 0.25]. No differences in PaO. Preoxygenation for 3 minutes before isoflurane mask induction of anesthesia and apnea does not significantly increase time until desaturation in hens.

Topics: Anesthesia, General; Animals; Apnea; Chickens; Cross-Over Studies; Female; Hemoglobins; Isoflurane; Oxygen; Prospective Studies; Rocuronium

As the transgender patient population continues to grow, health care providers will need to become aware of elements unique to the transgender community in order to provide the highest quality of care. Neuromuscular blockade with succinylcholine is routinely administered to patients undergoing electroconvulsive therapy (ECT). Decreased amounts or activity of pseudocholinesterase in serum can lead to prolonged duration of muscle paralysis. Causes of reduced action by pseudocholinesterase include genetically abnormal enzymes, reduced hepatic production, pregnancy, and various drug interactions. Estrogen supplementation taken by transitioning patients may affect the duration of neuromuscular blockade.This is a case of a 32-year-old male-to-female transgender patient with prolonged apnea following ECT treatment for severe, refractory depression. Further investigation revealed the patient was on estrogen therapy as a part of her transition and laboratory testing demonstrated reduced serum pseudocholinesterase activity. Further laboratory testing demonstrated reduced serum pseudocholinesterase activity. Succinylcholine dosing was titrated to an appropriate level to avoid prolonged apnea in subsequent ECT treatments. Physicians and other health care providers are faced with a unique population in the transgender community and must be aware of distinctive circumstances when providing care to this group. Of specific interest, many transitioning and transitioned patients can be on chronic estrogen supplementation. Neuromuscular blockade in those patients require attention from the anesthesiology care team as estrogen compounds may decrease pseudocholinesterase levels and lead to prolonged muscle paralysis from succinylcholine.

Topics: Adult; Androstanols; Apnea; Butyrylcholinesterase; Depressive Disorder, Treatment-Resistant; Drug Interactions; Electroconvulsive Therapy; Estrogens; Female; gamma-Cyclodextrins; Humans; Male; Neuromuscular Depolarizing Agents; Rocuronium; Sex Reassignment Procedures; Succinylcholine; Sugammadex; Transgender Persons

Topics: Apnea; Fasciculation; Humans; Oxygen; Rocuronium; Succinylcholine

Topics: Androstanols; Apnea; Butyrylcholinesterase; Contraindications; Electroconvulsive Therapy; gamma-Cyclodextrins; Humans; Male; Metabolism, Inborn Errors; Middle Aged; Neuromuscular Nondepolarizing Agents; Rocuronium; Succinylcholine; Sugammadex

We report the anesthetic management of a patient with catatonic schizophrenia and pseudocholinesterase deficiency, using the nondepolarizing neuromuscular blocking drug, rocuronium, reversed by its specific reversal agent, sugammadex, for a series of electroconvulsive therapy sessions. Rocuronium and sugammadex were used every 48 hours for 8 consecutive times and proved to be an effective and safe combination in a situation where succinylcholine was contraindicated.

Topics: Adult; Androstanols; Apnea; Butyrylcholinesterase; Cholinesterases; Drug Hypersensitivity; Drug Interactions; Electroconvulsive Therapy; gamma-Cyclodextrins; Humans; Male; Metabolism, Inborn Errors; Neuromuscular Nondepolarizing Agents; Rocuronium; Schizophrenia, Catatonic; Sugammadex

In general, there is a response time between actual arterial hypoxemia and its detection by pulse oximeters. We compared the desaturation and resaturation response times between two types of pulse oximeters, transmission and reflectance pulse oximeters, to find out which oximeter has a more rapid response time.. Thirty-three ASA 1 or 2 patients were enrolled in this study. A transmission pulse oximeter was placed on the index finger and a reflectance pulse oximeter was placed on the forehead and monitored simultaneously. After the induction of general anesthesia without pre-oxygenation, we waited until the oxygen saturation value of any of two pulse oximeters declined to 90%, and then mask ventilation was started with 100% oxygen. Oxygen saturation was recorded at an interval of 2 s during this time.. The desaturation response time of SpO(2) to 95% after apnea was 82.0 s (interquartile range: 67.0-98.5 s) vs. 94.0 s (interquartile range: 84.0-106.5 s) (P<0.001) and SpO(2) to 90% was 94.0 s (interquartile range: 75.5-109.5 s) vs. 100.0 s (interquartile range: 84.5-114.5 s) (P<0.001) in the reflectance and transmission oximeters, respectively. The resaturation response time from mask ventilation to 100% SpO(2) was 23.2+/-5.6 vs. 28.9+/-7.6 s (P<0.001) in the reflectance and transmission oximeters, respectively.. In clinical situations in which rapid changes in oxygen saturation are expected, we recommend the forehead reflectance pulse oximeter because it responds more quickly in detecting oxygen desaturation and resaturation compared with the transmission pulse oximeter.

Topics: Adult; Androstanols; Anesthetics, Intravenous; Apnea; Breast; Equipment Design; Female; Fentanyl; Fingers; Forehead; Humans; Hypoxia; Middle Aged; Neuromuscular Nondepolarizing Agents; Oximetry; Oxygen; Propofol; Respiration, Artificial; Rocuronium; Thyroidectomy; Time Factors; Young Adult

A patient developed prolonged apnea after emergency cesarean section. The patient was a 38-year-old primiparous woman with myoma uteri and her body weight was 44.8 kg. She received intravenous magnesium sulfate 1 g x hr(-1) as tocolytic agent for threatened premature delivery. We performed rapid sequence induction of anesthesia with thiopental 250 mg and rocuronium 50 mg because she was suspected of full stomach. After the intubation, we did not administer any muscle relaxants during the operation. After the operation which was finished in 65 minutes, the effect of rocuronium remained for more than 100 minutes after its administration probably due to hypermagnesemia. Rocuronium shows rapid onset, and several studies indicate that it can be used for rapid sequence induction instead of suxamethonium. But rocuronium should be used carefully and its effect should be monitored in a patient with hypermagnesemia.

Topics: Adult; Androstanols; Anesthesia, General; Anesthesia, Obstetrical; Apnea; Cesarean Section; Emergencies; Female; Humans; Magnesium; Magnesium Sulfate; Pregnancy; Rocuronium; Time Factors; Tocolytic Agents

Topics: Androstanols; Apnea; Humans; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Oxygen; Research Design; Rocuronium; Succinylcholine