rocuronium and Fractures--Bone

Sugammadex allows rapid recovery from rocuronium-induced neuromuscular blockade. Succinylcholine is often used for brief surgeries but is associated with myalgia, headache, histamine release, and increased lactate levels. Thus, we hypothesized that succinylcholine may affect emergence agitation (EA) and compared the effects of succinylcholine and rocuronium-sugammadex on EA in patients undergoing closed reduction of a nasal bone fracture under general anesthesia.. Forty-two patients were prospectively enrolled and allocated randomly to the succinylcholine group (group SC) or the rocuronium-sugammadex group (group RS; each n = 21). Neuromuscular block and its reversal were achieved with succinylcholine and normal saline in group SC, whereas rocuronium and sugammadex were administered in group RS. After surgery, the incidence of EA as a primary outcome, the incidence of dangerous EA, and duration of EA as secondary outcomes were compared.. The incidence of EA was higher in group SC than in group RS (90.5% vs. 47.6%, respectively; relative risk [RR] 4.3; 95% confidence interval [CI] 1.2 to 15.7; P = .006). The incidence of dangerous EA increased in group SC compared to group RS (33.3% vs. 4.8%, respectively; RR 2.1; 95% CI 1.3 to 3.4; P = .045). The duration of agitation was longer in group SC than in group RS [106.5 (65.1) vs. 40.4 (26.0) sec; mean difference 66.1 s; 95% CI 31.0 to 101.1; effect size 1.3; P = .001).. Succinylcholine increases the incidence, severity, and duration of EA compared to rocuronium-sugammadex in patients undergoing closed reduction of a nasal bone fracture.. CRiS Registration number KCT0002673. Initial registration date was 31 January 2018 (Retrospectively registered).

Topics: Adult; Anesthesia, General; Closed Fracture Reduction; Double-Blind Method; Emergence Delirium; Female; Fractures, Bone; Humans; Male; Middle Aged; Nasal Bone; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Prospective Studies; Rocuronium; Succinylcholine; Sugammadex; Young Adult

To report on general anesthesia management in amyotrophic lateral sclerosis.. A 47-year-old man presented with fracture of the humerus. The patient was diagnosed with amyotrophic lateral sclerosis. General anesthesia was induced with propofol, rocuronium and remifentanil. After uneventful surgical repair, TOF (train-of-four) ratio reached >0.90 at the end of operation. However, muscle strength and tidal volume were inadequate. After sugammadex 2 mg kg(-1) i.v. was given, the patient was extubated 120 s later.. This case highlights that rocuronium and sugammadex can be used safely in patients with amyotrophic lateral sclerosis undergoing surgery with general anesthesia.

Topics: Amyotrophic Lateral Sclerosis; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Fractures, Bone; gamma-Cyclodextrins; Humans; Humerus; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Orthopedic Procedures; Patient Safety; Rocuronium; Sugammadex

Topics: Aged; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Dermatomyositis; Elbow Joint; Fractures, Bone; gamma-Cyclodextrins; Humans; Male; Neuromuscular Diseases; Neuromuscular Nondepolarizing Agents; Rocuronium; Sugammadex; Time Factors; Treatment Outcome

Muscular dystrophy requires cautious administration of muscle relaxants due to variable sensitivity and prolonged effects. A 43-year-old man with muscular dystrophy was scheduled for open reduction and internal fixation under general anesthesia. Following patient's TOF ratio with the muscle relaxation monitor, 80 minutes after rocuronium bromide (Rb) administration, we found that TOF ratio was over 0.9. We used sugammadex 4 mg x kg(-1) to reverse Rb-induced neuromuscular block, and then extubated. There was no clinical adverse effect on his muscular function and no respiratory distress after the use of sugammadex in the postoperative phase. Reversal of Rb-induced neuromuscular block by sugammadex in a patient with muscular dystrophy is efficient and safe.

Topics: Adult; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Clavicle; Fracture Fixation, Internal; Fractures, Bone; gamma-Cyclodextrins; Humans; Male; Monitoring, Intraoperative; Muscle Relaxation; Muscular Dystrophies; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Rocuronium; Sugammadex

Topics: Abnormalities, Multiple; Alfentanil; Androstanols; Anesthesia; Anesthesia, Epidural; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Anesthetics, Local; Bupivacaine; Child, Preschool; Desflurane; Female; Femur; Fractures, Bone; Hip Dislocation, Congenital; Humans; Intellectual Disability; Isoflurane; Monitoring, Intraoperative; Muscular Diseases; Neuromuscular Nondepolarizing Agents; Orthopedic Procedures; Propofol; Rocuronium; Sufentanil; Syndrome