rocuronium and Ileus

Neuromuscular blockers (NMBs) used during surgery have historically been reversed with acetylcholinesterase inhibitors and anticholinergic agents, which can slow gastrointestinal motility. Sugammadex (SUG) provides NMB reversal with minimal effects on gastrointestinal motility.. The purpose of this study was to determine if SUG for reversal of NMB is associated with decreased time to first bowel movement (BM) following laparoscopic colorectal surgery.. A retrospective cohort analysis divided 224 patients undergoing laparoscopic colorectal surgeries based on whether they received SUG or a combination of neostigmine and glycopyrrolate (NG) for NMB reversal. The primary outcome was time (in hours) from NMB reversal until first recorded BM. Secondary end points were postoperative ileus, postoperative nausea and vomiting, prevalence of residual NMB, and hospital length of stay. The relationship between NMB reversal agent and outcomes were analyzed using multivariable linear regression and Cox proportional hazards model.. There were 128 patients who received NG and 96 who received SUG. Time to first BM was faster in the SUG group by 11.7 hours (. This represents the first report demonstrating faster return of BM following colorectal surgery with SUG when compared with NG. Application of these data may add another tool to enhance recovery after colorectal surgery.

Topics: Cholinesterase Inhibitors; Cohort Studies; Colorectal Surgery; Drug Therapy, Combination; Female; Gastrointestinal Motility; Glycopyrrolate; Humans; Ileus; Laparoscopy; Middle Aged; Neostigmine; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Retrospective Studies; Rocuronium; Sugammadex; Time Factors

Amyotrophic lateral sclerosis (ALS) is a degenerative disease involving motor neurons. The anesthetic problem is increased susceptibility to non-depolarizing muscle relaxants and the feasibility of spinal and epidural anesthesia. An 86-year-old man with ALS underwent colostomy to the ileus. We chose general anesthesia with propofol, remifentanil, rocuronium and sugammadex. We administered 30 mg (0.52 mg . kg-1) of rocuronium only for induction. TOF-count was 2 at the end of operation. At spontaneous neuromuscular recovery to TOF-count 3, we administered sugammadex 2.1 mg . kg-1. The patient emerged from general anesthesia smoothly, and was extubated. Post-operative course was uneventful. Our anesthetic management of ALS patient using sugammadex was successful. Further evidence is required to establish appropriate use of sugammadex for ALS patients.

Topics: Aged, 80 and over; Amyotrophic Lateral Sclerosis; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Colostomy; gamma-Cyclodextrins; Humans; Ileus; Intraoperative Care; Male; Neuromuscular Depolarizing Agents; Rocuronium; Sugammadex