rocuronium and Breast-Neoplasms

Rocuronium, a common neuromuscular blocking agent, is mainly excreted unchanged in urine (10-25%) and bile (>70%). Age, sex, liver blood flow, smoking, medical conditions, and ethnic background can affect its pharmacological actions. However, reasons for the wide variation in rocuronium requirements are mostly unknown. We hypothesised that pharmacogenetic factors might explain part of the variation.. One thousand women undergoing surgery for breast cancer were studied. Anaesthesia was maintained with propofol (50-100 μg kg. The final patient population comprised 918 individuals. Of the clinical variables tested, age, BMI, ASA physical status, and total dose of propofol correlated significantly (all P<0.001) with the rocuronium dose in a linear regression model. The GWAS highlighted one genome-wide significant locus in chromosome 12. The single-nucleotide polymorphisms (SNPs) with the most significant evidence of association were located in or near SLCO1A2. The two top SNPs, rs7967354 (P=5.3e. Genetic variation in the gene SLCO1A2, encoding OATP1A2, an uptake transporter, accounted for 4% of the variability in rocuronium consumption. The underlying mechanism remains unknown.

Topics: Breast Neoplasms; Dose-Response Relationship, Drug; Female; Genetic Variation; Genome-Wide Association Study; Humans; Middle Aged; Neuromuscular Nondepolarizing Agents; Organic Anion Transporters; Pharmacogenetics; Polymorphism, Single Nucleotide; Propofol; Prospective Studies; Remifentanil; Rocuronium

Aggressive surgical removal of the primary tumour is the preferred treatment, but with tumour progression, some tumours cannot be completely removed surgically. Anaesthetics are administered to facilitate surgery. However, anaesthetics act as a potential factor in tumour recurrence or metastasis.. Normal breast cells and cancer breast cells were treated with different doses of muscle-relaxant anaesthetics. The effects on breast cancer cell invasion, adhesion and migration of these anaesthetics were then investigated using in vitro models.. With increasing dose of rocuronium bromide and suxamethonium chloride CRS, the number of MCF-10A and MCF-7 cells, but not that of MDA-MB-231 cells, decreased. There was almost no difference in the number of cells when the three cell lines were treated with different doses of vecuronium bromide. The study also demonstrated that rocuronium bromide promoted the invasion, adhesion and growth of MDA-231 cells, while suxamethonium chloride CRS had no effect. Interestingly, vecuronium bromide did not affect the motility and invasion of breast cancer cells significantly.. An understanding of the effect of anaesthetics and their impact on tumour metastasis is important, thus using an appropriate aesthetic strategy could improve long-term survival in some patients.

Topics: Androstanols; Breast Neoplasms; Cell Adhesion; Cell Movement; Cell Proliferation; Disease Progression; Dose-Response Relationship, Drug; Female; Humans; MCF-7 Cells; Neoplasm Invasiveness; Neuromuscular Depolarizing Agents; Risk Assessment; Rocuronium; Succinylcholine; Vecuronium Bromide

A neuromuscular blocking drug (NMBD) induced neuromuscular blockade (NMB) in patients with myasthenia gravis usually dissipates either spontaneously or by administration of neostigmine. We administered sugammadex to a patient with myasthenia gravis to reverse a rocuronium-induced profound NMB. NMBDs predispose such patients to severe postoperative residual paralysis and respiratory complications. Sugammadex binds steroidal NMBDs and, therefore reverses a rocuronium or vecuronium-induced NMB, without interfering with cholinergic transmission. A rapid and complete recovery from profound NMB was achieved and no adverse events were observed. This case suggests that sugammadex is a safe and effective antagonist of a rocuronium induced NMB blockade in patients with myasthenia gravis.

Topics: Aged; Androstanols; Anesthesia Recovery Period; Breast Neoplasms; Disease Susceptibility; Female; gamma-Cyclodextrins; Humans; Mastectomy; Myasthenia Gravis; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Paralysis; Postoperative Complications; Preanesthetic Medication; Rocuronium; Sentinel Lymph Node Biopsy; Sugammadex