rocuronium and Arrhythmias--Cardiac

Myocardial ischemia, as well as the induction agents used in anesthesia, may cause corrected QT interval (QTc) prolongation. The objective of this randomized, double-blind trial was to determine the effects of high- vs conventional-dose bolus rocuronium on QTc duration and the incidence of dysrhythmias following anesthesia induction and intubation. Fifty patients about to undergo coronary artery surgery were randomly allocated to receive conventional-dose (0.6 mg/kg, group C, n=25) or high-dose (1.2 mg/kg, group H, n=25) rocuronium after induction with etomidate and fentanyl. QTc, heart rate, and mean arterial pressure were recorded before induction (T0), after induction (T1), after rocuronium (just before laryngoscopy; T2), 2 min after intubation (T3), and 5 min after intubation (T4). The occurrence of dysrhythmias was recorded. In both groups, QTc was significantly longer at T3 than at baseline [475 vs 429 ms in group C (P=0.001), and 459 vs 434 ms in group H (P=0.005)]. The incidence of dysrhythmias in group C (28%) and in group H (24%) was similar. The QTc after high-dose rocuronium was not significantly longer than after conventional-dose rocuronium in patients about to undergo coronary artery surgery who were induced with etomidate and fentanyl. In both groups, compared with baseline, QTc was most prolonged at 2 min after intubation, suggesting that QTc prolongation may be due to the nociceptive stimulus of intubation.

Topics: Aged; Androstanols; Anesthesia, General; Anesthetics, Intravenous; Arrhythmias, Cardiac; Arterial Pressure; Coronary Vessels; Double-Blind Method; Electrocardiography; Etomidate; Female; Fentanyl; Heart Rate; Humans; Intubation; Laryngoscopy; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Rocuronium; Statistics, Nonparametric

The aim of this study was to analyze clinical characteristics of rocuronium as premedication for nonemergent intubation in infants.. Preterm infants requiring nonemergent intubation were randomized to receive atropine and fentanyl with or without rocuronium. Outcomes, patient characteristics and intubator's experience were noted. Onset, duration and degree of clinical paralysis were recorded for rocuronium group and for older infants receiving rocuronium per unit protocol.. Forty-four intubations were randomized (20 rocuronium, 24 control). Groups were similar in chronological and corrected gestational age, weight and intubator's experience. Successful intubation on first attempt was achieved in 35% of intubations under rocuronium vs 8% of controls; rocuronium was the only significant variable by logistic regression (odds ratio=0.052, P=0.029). Complete paralysis was reported in 80% of 57 rocuronium intubations; onset ranged from 14 to 178 s (65.9±43.4), and duration from 1 to 60 min (16.3±13.5).. Rocuronium facilitated successful intubation and provided clinical paralysis quickly in most infants.

Topics: Androstanols; Arrhythmias, Cardiac; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Intubation, Intratracheal; Logistic Models; Male; Neuromuscular Nondepolarizing Agents; Odds Ratio; Rocuronium; Term Birth; Time Factors; Treatment Outcome

Sugammadex reverses the effects of rocuronium- and vecuronium-induced neuromuscular blockade, which are achieved by encapsulation. It is known that some non-antiarrhythmic drugs have the potential to delay cardiac repolarization and it is therefore recommended that the effects of all new drugs on the QT interval are assessed.. This thorough corrected QT (QTc) study evaluated the effect of sugammadex alone and in combination with rocuronium or vecuronium on the individually corrected QTc interval (QTcI).. This was a randomized, double-blind, six-period crossover, placebo-controlled study, with an open-label active-controlled component (moxifloxacin). The study was designed according to International Conference on Harmonization (ICH) E14 guidelines. The study was conducted in a clinical research unit from November 2006 to April 2007. Healthy male and female subjects (n = 84) were enrolled in the study. Subjects were randomized to six treatment sequences comprising single intravenous doses of placebo, moxifloxacin 400 mg (positive control), sugammadex 4 mg/kg, sugammadex 32 mg/kg, sugammadex 32 mg/kg with rocuronium 1.2 mg/kg and sugammadex 32 mg/kg with vecuronium 0.1 mg/kg. Triplicate ECGs were recorded at 13 timepoints up to 23.5 hours after study drug administration and QT intervals were evaluated manually under blinded conditions. The primary outcome was the largest time-matched mean difference in QTcI change from baseline compared with placebo across the 13 timepoints up to 23.5 hours after study drug administration. Blood samples were also collected for pharmacokinetic analysis.. Of the 84 randomized healthy subjects, 80 completed the study. After moxifloxacin, QTcI prolongations were observed compared with placebo; the lower limit of the one-sided 95% confidence interval (CI) for the largest time-matched mean difference in QTcI change compared with placebo was 20.8 msec (90% CI 18.5, 23.1), thus exceeding the ICH E14 safety margin of 5 msec and demonstrating assay sensitivity. In contrast, the largest time-matched mean difference in QTcI (msec) from placebo with sugammadex treatments ranged from 2.1 (sugammadex 4 mg/kg alone) to 4.3 (sugammadex 32 mg/kg with vecuronium 0.1 mg/kg). For the largest time-matched mean difference in QTcI change compared with placebo the corresponding upper limit of the one-sided 95% CI was well below the 10 msec margin for both sugammadex doses. Telemetry results revealed that one subject experienced a non-sustained ventricular tachycardia 4 hours after sugammadex 32 mg/kg, which was self-terminating after 20 beats and considered unlikely to be drug related. Pharmacokinetic-QTc analysis showed a statistically significant (p < 0.01) relationship between sugammadex plasma concentration and QTcI; however, at mean maximum plasma concentrations of the therapeutic and supra-therapeutic sugammadex dose, the predicted one-sided upper 95% CI for the largest time-matched QTcI difference from placebo was below 10 msec. Rocuronium or vecuronium co-administration did not affect the relationship between sugammadex concentrations and QTc.. Based on the results of this study of healthy subjects, it can be concluded that sugammadex alone or in combination with rocuronium or vecuronium is not associated with QTc prolongation.

Topics: Adolescent; Adult; Androstanols; Arrhythmias, Cardiac; Aza Compounds; Cross-Over Studies; Double-Blind Method; Electrocardiography; Female; Fluoroquinolones; gamma-Cyclodextrins; Heart Rate; Humans; Injections, Intravenous; Male; Middle Aged; Models, Biological; Moxifloxacin; Neuromuscular Nondepolarizing Agents; Quinolines; Risk Assessment; Risk Factors; Rocuronium; Sugammadex; Time Factors; Vecuronium Bromide; Young Adult

The oculocardiac reflex (OCR) may be activated during squint surgery. The aim of this study was to test whether rocuronium 0.4 mg kg(-1) could reduce the frequency of OCR, and also whether a single dose of succinylcholine 1 mg kg(-1) could affect the frequency of OCR during anesthesia with halothane in a nitrous oxide/oxygen mixture.. A total of 161 ASA I children, 3-10 years old, undergoing elective surgery of the medial rectus muscle (MRM) were randomly assigned to three groups. Group R (n = 51), received 0.4 mg kg(-1) of rocuronium intravenously before endotracheal intubation. Group S (n = 58) received 1 mg kg(-1) of succinylcholine. Group C (controls, n = 52) received no relaxant. Oculocardiac reflex was defined as a reduction in heart rate (HR) > or = 15% and/or the appearance of any other arrhythmias, during manipulation of the MRM. Analysis of variance (anova), chi-squared, Kruskal-Wallis, and Student's t-tests were used for statistical analysis; P< 0.05 was considered statistically significant.. In group R, OCR occurred in 15/51 (29%) of children, in group S in 31/58 (53%), and in group C in 23/52 (44%) (chi2 = 6.46, P = 0.049). In group R, the incidence of arrhythmias such as nodal rhythms, supraventricular and ventricular premature beats was 6%, compared with 22% in group S and 19% in group C (chi2 = 6.01, P = 0.040). However, there was no reduction in the occurrence of bradycardia (chi2 = 0.16, P = 0.924).. Rocuronium reduced the frequency of OCR, mainly by reducing the incidence of supraventricular and ventricular premature beats.

Topics: Androstanols; Anesthesia, Inhalation; Anesthetics, Inhalation; Arrhythmias, Cardiac; Child; Child, Preschool; Electrocardiography; Female; Halothane; Heart Rate; Humans; Intraoperative Complications; Male; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Reflex, Oculocardiac; Rocuronium; Strabismus; Succinylcholine

Few patients with cyanotic congenital heart disease reach adulthood without a cardiac operation. The prognosis for ''unrepaired'' pulmonary atresia with ventricular septal defect is approximately 8% in the 1st decade of age. Consequently, the number of adults with this particular heart disease (unrepaired) who are expected to need a non-cardiac surgery is extremely low. General anesthesia may aggravate the preexisting right to left shunt and lead to persistent severe hypoxemia. The goal of anesthetic management should be to maintain intravascular volume. Systemic and pulmonary vascular resistance changes, such as might occur due to acidosis, hypothermia, hypercarbia or excessive airway pressures, should be avoided. Maintenance of preload, contractility and sinus rhythm is of major importance. The complex pathophysiology of such heart disease, in addition to the circumstances of emergency operation, exacerbate the total anesthetic risk. We present here a rare case of an acute appendectomy with successful outcome in an adult with pulmonary atresia and ventricular septal defect.

Topics: Androstanols; Anesthesia, Intravenous; Appendectomy; Appendicitis; Arrhythmias, Cardiac; Contraindications; Cyanosis; Embolism, Paradoxical; Emergencies; Endocarditis, Subacute Bacterial; Female; Fentanyl; Heart Defects, Congenital; Humans; Intraoperative Complications; Ketamine; Narcotics; Oxygen; Propofol; Risk; Rocuronium; Ultrasonography; Vascular Resistance; Young Adult

Topics: Adrenergic beta-Agonists; Adult; Anaphylaxis; Androstanols; Anesthesia, General; Arrhythmias, Cardiac; Dobutamine; Electrocardiography; Female; Gynecologic Surgical Procedures; Humans; Hypotension; Neuromuscular Nondepolarizing Agents; Rocuronium; Stroke; Uterine Cervical Neoplasms