rocuronium and Hypotension

The objective was to determine whether the use of fentanyl with ketamine for emergency department (ED) rapid sequence intubation (RSI) results in fewer patients with systolic blood pressure (SBP) measurements outside the pre-specified target range of 100-150 mm Hg following the induction of anesthesia. Methods This study was conducted in the ED of five Australian hospitals. A total of 290 participants were randomized to receive either fentanyl or 0.9% saline (placebo) in combination with ketamine and rocuronium, according to a weight-based dosing schedule. The primary outcome was the proportion of patients in each group with at least one SBP measurement outside the prespecified range of 100-150 mm Hg (with adjustment for baseline abnormality). Secondary outcomes included first-pass intubation success, hypotension, hypertension and hypoxia, mortality, and ventilator-free days 30 days following enrollment.. A total of 142 in the fentanyl group and 148 in the placebo group commenced the protocol. A total of 66% of patients receiving fentanyl and 65% of patients receiving placebo met the primary outcome (difference = 1%, 95% CI = -10 to 12). Hypotension (SBP ≤ 99 mm Hg) was more common with fentanyl (29% vs. 16%; difference = 13%, 95% CI = 3% to 23%), while hypertension (≥150 mm Hg) occurred more with placebo (69% vs. 55%; difference = 14%, 95% CI = 3 to 24). First-pass success rate, 30 day mortality, and ventilator-free days were similar.. There was no difference in the primary outcome between groups, although lower blood pressures were more common with fentanyl. Clinicians should consider baseline hemodynamics and postinduction targets when deciding whether to use fentanyl as a coinduction agent with ketamine.

Topics: Australia; Emergency Service, Hospital; Fentanyl; Humans; Hypertension; Hypotension; Intubation, Intratracheal; Ketamine; Rapid Sequence Induction and Intubation; Rocuronium

We compared the effect of pre-treatment with ephedrine 75, 100, 150 microg kg(-1) and saline on intubating conditions and haemodynamics during rapid tracheal intubation using propofol and rocuronium.. One hundred adult patients randomized into one of the four groups-PE 75, PE 100, PE 150, and saline (control) groups-were pre-treated with i.v. ephedrine 75, 100, 150 microg kg(-1) or saline, respectively, 1 min before rapid tracheal intubation using propofol 2.5 mg kg(-1) and rocuronium 0.6 mg kg(-1). A blinded anaesthesiologist assessed the intubating conditions. Heart rate and mean arterial pressure were recorded before anaesthesia induction (baseline), post-induction, and every minute after intubation for 5 min. A 20% change in haemodynamic variables from baseline was regarded as clinically significant. Data were analysed using anova test with post hoc Tukey's test and chi2 or Fisher's exact test. P < 0.05 was regarded as significant.. Patient characteristics, baseline heart rate, and mean arterial pressure were comparable between the groups. Intubating conditions were significantly better in the PE 75 (P = 0.003) and PE 100 (P = 0.001) groups. A significant increase in heart rate was observed in the PE 75 and PE 150 groups when compared with the saline group. A statistically significant difference in mean arterial pressure was noted between PE 75 and PE 150 groups and between PE 150 and saline groups at most of the time intervals. However, when considering the clinical significance of these, all groups were comparable (P > 0.05).. Ephedrine either 75 or 100 microg kg(-1) given before rapid tracheal intubation using propofol and rocuronium bromide improves the intubation conditions. It is not effective in preventing the hypotension which follows ensuing induction of anaesthesia.

Topics: Adolescent; Adult; Androstanols; Anesthesia, General; Anesthetics, Intravenous; Blood Pressure; Dose-Response Relationship, Drug; Double-Blind Method; Ephedrine; Female; Heart Rate; Humans; Hypotension; Intraoperative Complications; Intubation, Intratracheal; Laryngoscopy; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Premedication; Propofol; Rocuronium; Vasoconstrictor Agents

To evaluate the neuromuscular, ventilatory, and cardiovascular effects of rocuronium and vecuronium.. Randomized, prospective, blinded study.. Tertiary care teaching center, single institution.. Patients undergoing elective coronary artery bypass graft procedure.. Patients received rocuronium, 1.0 mg/kg (n = 17), or vecuronium, 0.15 mg/kg (n = 15), during fentanyl induction of anesthesia.. Measures consisted of time to visual loss of orbicularis oculi twitches in response to facial nerve stimulation, ease of mask ventilation, hemodynamics, need for vasoactive drugs, and tracheal intubating conditions. Median time to twitch loss was faster (p < 0.05) after rocuronium (60 s) than after vecuronium (>84 s). Within 45 seconds, only 3 of 17 patients in the rocuronium group had moderate-to-severe difficulty with mask ventilation versus 12 of 15 patients in the vecuronium group (p < 0.05). Tracheal intubating conditions were excellent in all patients after rocuronium. In the vecuronium group, intubating conditions were excellent in 46%, good in 27%, and poor in 27% (p < 0.05 vrocuronium). Patients receiving vecuronium were more likely to require ephedrine and phenylephrine for hypotension (10/15 patients v 5/17 patients for rocuronium, p < 0.05). There were no clinically important differences in hemodynamic variables, oxygen metabolism, or myocardial ischemia between groups.. During narcotic induction of anesthesia, rocuronium was associated with lower requirement for vasopressors, faster onset of neuromuscular blockade, and better conditions for mask ventilation and tracheal intubation compared with vecuronium.

Topics: Androstanols; Anesthesia; Anesthetics, Intravenous; Coronary Artery Bypass; Double-Blind Method; Female; Fentanyl; Hemodynamics; Humans; Hypotension; Intubation, Intratracheal; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Oxygen; Oxygen Consumption; Prospective Studies; Respiration, Artificial; Rocuronium; Vecuronium Bromide

Post-intubation hypotension (PIH) after prehospital emergency anaesthesia (PHEA) is prevalent and associated with increased mortality in trauma patients. The objective of this study was to compare the differential determinants of PIH in adult trauma patients undergoing PHEA.. This multi-centre retrospective observational study was performed across three Helicopter Emergency Medical Services (HEMS) in the UK. Consecutive sampling of trauma patients who underwent PHEA using a fentanyl, ketamine, rocuronium drug regime were included, 2015-2020. Hypotension was defined as a new systolic blood pressure (SBP) < 90 mmHg within 10 min of induction, or > 10% reduction if SBP was < 90 mmHg before induction. A purposeful selection logistic regression model was used to determine pre-PHEA variables associated with PIH.. During the study period 21,848 patients were attended, and 1,583 trauma patients underwent PHEA. The final analysis included 998 patients. 218 (21.8%) patients had one or more episode(s) of hypotension ≤ 10 min of induction. Patients > 55 years old; pre-PHEA tachycardia; multi-system injuries; and intravenous crystalloid administration before arrival of the HEMS team were the variables significantly associated with PIH. Induction drug regimes in which fentanyl was omitted (0:1:1 and 0:0:1 (rocuronium-only)) were the determinants with the largest effect sizes associated with hypotension.. The variables significantly associated with PIH only account for a small proportion of the observed outcome. Clinician gestalt and provider intuition is likely to be the strongest predictor of PIH, suggested by the choice of a reduced dose induction and/or the omission of fentanyl during the anaesthetic for patients perceived to be at highest risk.

Topics: Adult; Anesthesia; Emergency Medical Services; Fentanyl; Humans; Hypotension; Intubation, Intratracheal; Middle Aged; Retrospective Studies; Rocuronium

It remains unclear whether reduced myocardial contractility, venous dilation with decreased venous return, or arterial dilation with reduced systemic vascular resistance contribute most to hypotension after induction of general anesthesia. We sought to assess the relative contribution of various hemodynamic mechanisms to hypotension after induction of general anesthesia with sufentanil, propofol, and rocuronium. In this prospective observational study, we continuously recorded hemodynamic variables during anesthetic induction using a finger-cuff method in 92 non-cardiac surgery patients. After sufentanil administration, there was no clinically important change in arterial pressure, but heart rate increased from baseline by 11 (99.89% confidence interval: 7 to 16) bpm (P < 0.001). After administration of propofol, mean arterial pressure decreased by 23 (17 to 28) mmHg and systemic vascular resistance index decreased by 565 (419 to 712) dyn*s*cm

Topics: Anesthetics; Anesthetics, Intravenous; Blood Pressure; Hemodynamics; Humans; Hypotension; Propofol; Rocuronium; Sufentanil

Differentiating between anaphylaxis and hypotension during general anaesthesia is difficult, especially when patients present with only hypotension and without any of the other classical features of anaphylaxis. We report the successful management of an anaphylactic reaction to rocuronium that presented as isolated hypotension in a 45-year-old Indonesian man presented with lacerations on the scalp and right pinna caused by an assault to the head after the induction of general anaesthesia, refractory to fluids and high doses of vasopressors. This case highlights that a possible indicator of anaphylaxis can be the presence of isolated hypotension during.

Topics: Anaphylaxis; Anesthesia, General; Humans; Hypotension; Indonesia; Male; Middle Aged; Rocuronium

Following the return of spontaneous circulation after out-of-hospital cardiac arrest, neurological dysfunction, airway or ventilatory compromise can impede transport to early percutaneous coronary intervention, necessitating pre-hospital or emergency department anaesthesia to facilitate this procedure. There are no published reports of the ideal induction agents in these patients. We sought to describe haemodynamic changes associated with induction of anaesthesia using a midazolam (0.1 mg.kg

Topics: Adult; Aged; Anesthesia; Anesthetics, Intravenous; Dose-Response Relationship, Drug; Emergency Medical Services; Female; Fentanyl; Guideline Adherence; Hemodynamics; Humans; Hypertension; Hypnotics and Sedatives; Hypotension; Male; Midazolam; Middle Aged; Neuromuscular Nondepolarizing Agents; Out-of-Hospital Cardiac Arrest; Retrospective Studies; Rocuronium

The danger of anaphylaxis, a rare but life threatening complication of general anesthesia (GA) can be summarized in two: 1. General Anesthesia masks the typical early signs of allergy which can be seen in an awake patient. 2. Anaphylaxis during GA manifests mostly as circulatory/ventilatory failures which can be interpreted as adverse effects of anesthetics or surgery and this can lead to critical delay of effective therapy. A 19-year-old female admitted for posterior spinal fusion and instrumentation (the 5th surgery in patient's life) desaturated seconds after intubation. Cardiopulmonary resuscitation (CPR) was started and the absence of cutaneous signs along with a loud holosystolic murmur were questioned. The patient was promptly resuscitated and allergy to rocuronium was confirmed by intradermal tests 6weeks later. Factors influencing decision making and potential etiology of the newly heard holosystolic murmur during anaphylaxis are discussed.

Topics: Adult; Anaphylaxis; Androstanols; Anesthesia, General; Anesthetics, Intravenous; Cardiopulmonary Resuscitation; Clinical Decision-Making; Drug Hypersensitivity; Female; Fentanyl; Humans; Hypotension; Intradermal Tests; Neuromuscular Nondepolarizing Agents; Propofol; Rocuronium; Scoliosis; Shock; Spinal Fusion; Systolic Murmurs; Vasoconstrictor Agents; Young Adult

Topics: Adult; Anaphylaxis; Androstanols; Anesthesia; Blood Pressure; Colostomy; Dose-Response Relationship, Drug; Epinephrine; Female; gamma-Cyclodextrins; Humans; Hypotension; Intraoperative Complications; Neuromuscular Nondepolarizing Agents; Obesity, Morbid; Rocuronium; Spinal Dysraphism; Sugammadex; Vasoconstrictor Agents

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