rocuronium and Muscular-Diseases

In the intensive care unit (ICU), neuromuscular blocking agent (NMBA) is occasionally used with sedatives and/or analgesics, for the management of mechanically-ventilated critically ill patients. For its application in ICU, close attention should be paid on the side effects unlikely seen during operation because the basal conditions of ICU patients are more serious and its infusion period is likely to be long. There have been reports of the prolonged weakness after the long term use of NMBA. The incidence of prolonged weakness increases when a corticosteroid is applied concurrently. These side effects are associated with increases in ICU and hospital stays, and healthcare costs. Strategy should be focused on its prevention. For example, routine monitoring with peripheral nerve stimulation and titration to the minimum dose of requirement, are relevant and effective. The application of NMBA in ICU is reviewed and rocuronium recently placed on market is within the scope of this article.

Topics: Adrenal Cortex Hormones; Analgesics; Androstanols; Contraindications; Drug Therapy, Combination; Humans; Hypnotics and Sedatives; Intensive Care Units; Monitoring, Physiologic; Muscular Diseases; Neuromuscular Blocking Agents; Paralysis; Respiration, Artificial; Rocuronium

To asses the effects of Rocuronium pretreatment on Succinylcholine induced Fasciculations and postoperative Myalgias.. A randomized double blind case control study was conducted in Department of Anaesthesia and Surgical Intensive Care Unit, Liaquat National Hospital, Karachi from October 2003 - April 2004. Sixty adults ASA I or II patients who presented for elective general surgical procedures were included in the study. The patients were divided in two groups of thirty each by a simple lottery method. Group "A" received placebo and group "B" received Rocuronium 0.1 mg/kg, one minute prior to induction with Pentothal Sodium 5 mg/kg, Suxamethonium, 1.5 mg/kg and Nalbuphine 10 mg / 70 kg. Fasciculations and intubation condition was assessed immediately after the induction of anaesthesia while post operative myalgias were assessed 6, 12 and 24 hours after surgery.. Fasciculations were noticed in group "A" as 100% (mild to severe) and in group "B" 13.3% (mild). Post operative myalgias at 6 and 12 hours after surgery were 76.66 % in group "A" and 16.66 in groups "B". After 24 hours in group "A' post operative myalgias were 93.33% and group "B" 23.33%.. It is concluded that pretreatment with Rocuronium reduced the incidence of myalgias, fasciculations and produced rapid precurarization in one minute thereby saving time on busy operating lists. They also allowed the early ambulation of patients in minor surgeries.

Topics: Adolescent; Adult; Androstanols; Double-Blind Method; Fasciculation; Female; Humans; Male; Middle Aged; Muscular Diseases; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Rocuronium; Succinylcholine; Young Adult

This study was undertaken to determine the effect of lidocaine pretreatment on reduction of succinylcholine-induced myalgia in patients undergoing general anesthesia for gynecological surgery. One hundred and thirty-five patients were assigned to one of three groups in a prospective, double blind, randomized manner. Group PS, the control group, received normal saline and succinylcholine 1.5 mg x kg(-1); Group LS, lidocaine 1.5 mg x kg(-1) and succinylcholine 1.5 mg x kg(-1); Group PR, normal saline and rocuronium 0.6 mg x kg(-1). Morphine 0.1 mg x kg(-1) iv was given for premedication and all patients were monitored with a noninvasive blood pressure monitor, ECG and pulse oximetry. Anesthesia was induced with 5 mg.kg(-1) thiopental iv. followed by succinylcholine (Group PS, LS) or rocuronium (Group PR) for tracheal intubation. Following administration of these agents, the presence, and degree of fasciculation were assessed visually on a four point scale by one investigator who was blinded to the drug administered. The blood pressure and heart rate of each patient were monitored on nine occasions. Twenty-four hours later, any myalgia experienced was assessed according to a structured questionaire and graded by a four point scale by one investigator blinded to the intraoperative management. The results indicate that muscle fasciculation was not found in Group PR while the patients in Group LS had a lower incidence of muscle fasciculation than those in Group PS (p < 0.001). At 24 h, the incidence of myalgia was higher in Group PS than in Group LS and PR (p < 0.05). A correlation was not found between the incidence of myalgia and the occurrence of muscle fasciculation. The changes in systolic and diastolic blood pressure and heart rate were not significant among the three groups. In conclusion, where succinylcholine is used, lidocaine is proven to be the useful pretreatment agent for the reduction of postoperative myalgia.

Topics: Adolescent; Adult; Aged; Analysis of Variance; Androstanols; Anesthetics, Local; Chi-Square Distribution; Double-Blind Method; Elective Surgical Procedures; Fasciculation; Female; Genital Diseases, Female; Hemodynamics; Humans; Lidocaine; Middle Aged; Muscular Diseases; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pain; Postoperative Complications; Prospective Studies; Rocuronium; Succinylcholine; Surveys and Questionnaires; Treatment Outcome

The purpose of this study was to assess the effect of rocuronium pretreatment on the succinylcholine-induced fasciculations, myalgia and biochemical changes, and to compare it with vecuronium pretreatment.. We have studied 60 female patients undergoing minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each was pretreated with either saline (control group), rocuronium 0.05 mg/kg (rocuronium group) or vecuronium 0.007 mg/kg (vecuronium group). Three min after the pretreatment, 1.5 mg/kg succinylcholine was injected. Single twitch responses to electrical stimulation were measured. Serum potassium and creatine kinase were respectively measured 5 min after succinylcholine and 24 h after operation. Fasciculations and myalgia on postoperative day 1 and day 2 were evaluated.. The incidence of fasciculations was lowest in the rocuronium group, followed by the vecuronium group, and was highest in the control group. The incidence of myalgia on postoperative day 1 was lower in the rocuronium and vecuronium groups than the control group. The increase of serum creatine kinase was similar among the three groups, but there was no increase in serum potassium concentration in any group. No differences of the single twitch responses to electrical stimulation were found between the rocuronium and vecuronium groups.. Rocuronium pretreatment was more effective in reducing fasciculations than was vecuronium pretreatment, but both were equally effective in preventing myalgia on postoperative day 1. This difference may reflect the differential activities of rocuronium and vecuronium at the neuromuscular junction. The increase of creatine kinase was not attenuated by any regimen.

Topics: Adult; Androstanols; Creatine Kinase; Double-Blind Method; Fasciculation; Female; Humans; Middle Aged; Muscular Diseases; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Potassium; Prospective Studies; Rocuronium; Succinylcholine; Vecuronium Bromide

To evaluate the efficacy of cisatracurium, rocuronium, and d-tubocurarine in preventing succinylcholine-induced fasciculations and postoperative myalgia in patients undergoing ambulatory surgery.. Randomized, prospective, placebo-controlled trial. Teaching hospital.. 80 ASA physical status I and II patients scheduled for elective ambulatory surgery with general anesthesia.. A standardized balanced anesthetic technique was used for all patients.. Patients were randomized to receive cisatracurium 0.01 mg/kg, rocuronium 0.06 mg/kg, d-tubocurarine 0.05 mg/kg, or saline, 3 minutes prior to intravenous (i.v.) succinylcholine 1.5 mg/kg. The intensity of fasciculations and intubating conditions were assessed using a four-point rating scale. In addition, the severity of myalgia was assessed using a four-point rating scale in the postanesthesia care unit and at 24 hours postoperatively. No patient complained of any side effects after the administration of the study drug. Fasciculations were observed less frequently (p < 0.05) in the d-tubocurarine and rocuronium groups compared with the placebo and cisatracurium groups. However, there was no difference between the d-tubocurarine group and the rocuronium group (21% vs. 10%, respectively). Although fasciculations occurred less frequently in the cisatracurium group than in the placebo group (59% vs. 85%, respectively), this difference did not reach statistical significance. There was no difference among the four groups in the intubating conditions or the incidence of postoperative myalgia.. Pretreatment with rocuronium and d-tubocurarine was superior to cisatracurium in preventing succinylcholine-induced fasciculations. However, pretreatment did not have any effect on the incidence of myalgia after ambulatory surgery.

Topics: Adult; Aged; Androstanols; Atracurium; Fasciculation; Female; Humans; Male; Middle Aged; Muscular Diseases; Neuromuscular Blocking Agents; Neuromuscular Depolarizing Agents; Pain; Prospective Studies; Rocuronium; Succinylcholine; Tubocurarine

We have studied, in 150 patients undergoing elective oral surgery, the effectiveness and sequelae of pretreatment with rocuronium for reducing myalgia after suxamethonium. Patients were allocated randomly to one of three groups: anaesthesia was induced with propofol and fentanyl, and group V received vecuronium 1 mg, group R rocuronium 6 mg and group P placebo pretreatment. Suxamethonium 1.5 mg kg-1 was given 60 s after the pretreatment agent. All patients received ketorolac 10 mg i.v. and morphine 10 mg i.m. for analgesia. The incidence of postoperative myalgia on day 1 after rocuronium (20%) was significantly less than after vecuronium (42%) (P < 0.05) or placebo (70%) (P < 0.01). By day 4 the incidence of myalgia was 28.6% in the rocuronium group, 46.3% in the vecuronium group and 95% in the placebo group. Intubating conditions were not affected adversely by any pretreatment regimen.

Topics: Adolescent; Adult; Aged; Androstanols; Double-Blind Method; Female; Humans; Male; Middle Aged; Muscular Diseases; Neuromuscular Depolarizing Agents; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Preanesthetic Medication; Prospective Studies; Rocuronium; Succinylcholine; Surgery, Oral; Vecuronium Bromide

Delayed recovery from anesthesia remains a very challenging subject for anesthesiologists. This case report describes the clinical course of delayed recovery from neuromuscular blockade after laparoscopic partial nephrectomy in a patient on simvastatin. The patient was hypertensive on regular treatment with oral captopril 25 mg twice daily and amlodipine 5 mg once daily and hypercholesterolemic on regular simvastatin 40 mg once daily with a normal electrocardiogram (ECG). All preoperative laboratory findings were within normal ranges. The patient was premedicated with midazolam 1 mg and general anesthesia was induced with fentanyl 2 µg/kg body weight, propofol 2 mg/kg and rocuronium bromide 0.6 mg/kg to facilitate tracheal intubation. Anesthesia was maintained with inhalation of isoflurane 1.0-1.5 % in 40 % oxygen-enriched air and 25 µg boluses of fentanyl. The patient did not require any additional rocuronium throughout surgery which was finished after 4 h. The patient most probably had preoperative simvastatin-induced myotoxicity. This potentiated the muscle relaxant effect of rocuronium bromide and was the reason for patient unresponsiveness and delayed postoperative recovery. We can conclude that anesthesiologists should preoperatively identify statin myotoxicity and to avoid neuromuscular blocking drugs for statin-treated patients. Also, preoperative adjustment of statin dosage may be recommended.

Topics: Androstanols; Anesthesia; Delayed Emergence from Anesthesia; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Laparoscopy; Middle Aged; Muscular Diseases; Nephrectomy; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Postoperative Complications; Rocuronium; Simvastatin

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

Topics: Androstanols; Fasciculation; Humans; Muscular Diseases; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pain; Rocuronium; Succinylcholine