rocuronium and Pain--Postoperative

Unlike other laparoscopic techniques, the peritoneum is not incised in laparoscopic totally extraperitoneal inguinal hernia repair (TEP), and the preperitoneal space is developed as the surgical field by blunt dissection and CO. Forty-two adult patients scheduled for unilateral TEP under general anesthesia with remifentanil and desflurane were randomly assigned to paralyzed or non-paralyzed groups. In the paralyzed group, rocuronium doses were administered to maintain post-tetanic count at ≤ 5 during surgery. Non-paralyzed subjects were not given any rocuronium. Postoperatively, surgeon-evaluated surgical conditions, assessed using a 100-mm visual analogue scale ranging from 0 mm (not acceptable) to 100 mm (excellent), were compared between the two groups. For evaluation of postoperative pain, the time from the end of anesthesia to the initial requirement of postoperative analgesia was compared by the log-rank test.. Median [interquartile range] score of surgical condition in the paralyzed and non-paralyzed groups were 84 [75-90] and 84 [78-87], respectively (P = 0.46). Significant differences in postoperative analgesic requirements between the two groups were not confirmed (P = 0.74).. NMB did not improve the surgical conditions nor reduce postoperative pain. NMB is not routinely needed for TEP just because it is a laparoscopic procedure.. The trial was registered in the UMIN clinical trials registry (UMIN000029683, October 24, 2017; Principal investigator: Masafumi Fujimoto, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000033920 ) prior to patient enrolment.

Topics: Adult; Hernia, Inguinal; Herniorrhaphy; Humans; Laparoscopy; Neuromuscular Blockade; Pain, Postoperative; Rocuronium; Surgical Mesh; Treatment Outcome

There is scarce data on the safety and efficacy of opioid-free anesthesia (OFA), in resource-limited settings due to the non-availability of dexmedetomidine, the reference OFA agent. We aimed to demonstrate the feasibility, efficacy and safety of a practical OFA protocol not containing dexmedetomidine, adapted for low-resource environments in very painful surgeries like gynecological surgery.. We conducted a randomized pilot study on ASA I and II women undergoing elective gynecological surgery at a tertiary care hospital in Cameroon. Patients were matched in a ratio of 1:1 into an OFA and a conventional general anesthesia (CGA) group. The OFA protocol entailed the intravenous (IV) magnesium sulfate, lidocaine, ketamine, dexamethasone, propofol, and rocuronium, followed by isoflurane and a continuous infusion of a calibrated mixture of magnesium sulfate, ketamine and clonidine. The CGA protocol was IV dexamethasone, diazepam, fentanyl, propofol, and rocuronium, followed by isoflurane and reinjections of fentanyl propofol and a continuous infusion of normal saline as placebo. The primary endpoints were the success rate of OFA, isoflurane consumption and intraoperative anesthetic complications. The secondary endpoints were postoperative pain intensity, postoperative complications, patient satisfaction assessed using the QoR-40 questionnaire and the financial cost of anesthesia.. We enrolled a total of 36 women undergoing gynecological surgery; 18 in the OFA group and 18 in the CGA group. The success rate of OFA was 100% with significant lesser consumption of isoflurane in the OFA group, no significant intraoperative complication and better intraoperative hemodynamic stability in the OFA group. Postoperatively, compared to the CGA group, the OFA group had statistically significantly less pain during the first 24 h, no morphine consumption for pain relief, had less hypoxemia during the first six hours, less paralytic ileus, less nausea and vomiting, no pruritus and better satisfaction. The mean financial cost of this adapted OFA protocol was statistically significant lesser than that of CGA.. This OFA regimen without dexmedetomidine for a low-resource setting has a promising success rate with few perioperative complications including mild intraoperative hemodynamic changes, decrease postoperative complications, pain, and opioid consumption in patients undergoing elective gynecology surgery.. This study was registered at clinicaltrials.gov on 03/02/2021 under the registration number NCT04737473.

Topics: Analgesics, Opioid; Anesthesia, General; Clonidine; Dexamethasone; Dexmedetomidine; Diazepam; Female; Fentanyl; Gynecologic Surgical Procedures; Humans; Isoflurane; Ketamine; Lidocaine; Magnesium Sulfate; Pain, Postoperative; Pilot Projects; Propofol; Rocuronium; Saline Solution

Succinylcholine remains the muscle relaxant of choice for rapid sequence induction (RSI) but has many adverse effects. High-dose rocuronium bromide may be an alternative to succinylcholine for RSI but recovery times are nearly doubled compared with a standard intubating dose of rocuronium. Magnesium sulfate significantly shortens the onset time of a standard intubating dose of rocuronium. We set out to investigate whether intravenous (IV) pretreatment with MgSO4 followed by a standard intubating dose of rocuronium achieved superior intubation conditions compared with succinylcholine.. Adults were randomized to receive a 15-minute IV infusion of MgSO4 (60 mg·kg-1) immediately before RSI with propofol 2 mg·kg-1, sufentanil 0.2 μg·kg-1 and rocuronium 0.6 mg·kg-1, or a matching 15-minute IV infusion of saline immediately before an identical RSI, but with succinylcholine 1 mg·kg-1. Primary end point was the rate of excellent intubating conditions 60 seconds after administration of the neuromuscular blocking agent and compared between groups using multivariable log-binomial regression model. Secondary end points were blood pressure and heart rate before induction, before and after intubation, and adverse events up to 24 hours postoperatively.. Among 280 randomized patients, intubating conditions could be analyzed in 259 (133 MgSO4-rocuronium and 126 saline-succinylcholine). The rate of excellent intubating conditions was 46% with MgSO4-rocuronium and 45% with saline-succinylcholine. The analysis adjusted for gender and center showed no superiority of MgSO4-rocuronium compared with saline-succinylcholine (relative risk [RR] 1.06, 95% confidence interval [CI], 0.81-1.39, P = .659). The rate of excellent intubating conditions was higher in women (54% [70 of 130]) compared with men (37% [48 of 129]; adjusted RR 1.42, 95% CI, 1.07-1.91, P = .017). No significant difference between groups was observed for systolic and diastolic blood pressures. Mean heart rate was significantly higher in the MgSO4-rocuronium group. The percentage of patients with at least 1 adverse event was lower with MgSO4-rocuronium (11%) compared with saline-succinylcholine (28%) (RR 0.38, 95% CI, 0.22-0.66, P < .001). With saline-succinylcholine, adverse events consisted mainly of postoperative muscle pain (n = 26 [19%]) and signs of histamine release (n = 13 [9%]). With MgSO4-rocuronium, few patients had pain on injection, nausea and vomiting, or skin rash during the MgSO4-infusion (n = 5 [4%]).. IV pretreatment with MgSO4 followed by a standard intubating dose of rocuronium did not provide superior intubation conditions to succinylcholine but had fewer adverse effects.

Topics: Adult; Blood Pressure; Double-Blind Method; Female; Heart Rate; Humans; Infusions, Intravenous; Intubation, Intratracheal; Magnesium Sulfate; Male; Middle Aged; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Rapid Sequence Induction and Intubation; Rocuronium; Sex Characteristics; Succinylcholine; Young Adult

Acceleromyography at the adductor pollicis located in a distal part of the body may not reflect the degree of neuromuscular blockade (NMB) at the proximally located muscles manipulated during lumbar surgery. We investigated the usefulness and characteristics of acceleromyographic monitoring at the trapezius for providing moderate NMB during lumbar surgery. Fifty patients were randomized to maintain a train-of-four count 1-3 using acceleromyography at the adductor pollicis (group A; n = 25) or the trapezius (group T; n = 25). Total rocuronium dose administered intraoperatively [mean ± SD, 106.4 ± 31.3 vs. 74.1 ± 17.6 mg; P < 0.001] and surgical satisfaction (median [IQR], 7 [5-8] vs. 5 [4-5]; P < 0.001) were significantly higher in group T than group A. Lumbar retractor pressure (88.9 ± 12.0 vs. 98.0 ± 7.8 mmHg; P = 0.003) and lumbar muscle tone in group T were significantly lower than group A. Time to maximum block with an intubating dose was significantly shorter in group T than group A (44 [37-54] vs. 60 [55-65] sec; P < 0.001). Other outcomes were comparable. Acceleromyography at the trapezius muscle during lumbar surgery required a higher rocuronium dose for moderate NMB than the adductor pollicis muscle, thereby the consequent deeper NMB provided better surgical conditions. Trapezius as proximal muscle may better reflect surgical conditions of spine muscle.

Topics: Adult; Double-Blind Method; Female; Humans; Intraoperative Care; Lumbar Vertebrae; Male; Middle Aged; Myography; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Rocuronium; Superficial Back Muscles; Young Adult

Spinal surgery is usually performed in the prone position using a posterior approach. However, the prone position may cause venous engorgement in the back and thus increase surgical bleeding with interruption of surgery. The prone position also affects cardiac output since large vessels are compressed decreasing venous return to the heart.. We hypothesised that deep neuromuscular blockade would be associated with less surgical bleeding during spinal surgery in the prone position.. Randomised, single blinded trial.. University teaching hospital.. Eighty-eight patients in two groups.. Patients were randomly assigned to moderate neuromuscular blockade or deep neuromuscular blockade. In the moderate neuromuscular blockade group, administration of rocuronium was adjusted such that the train-of-four count was one to two. In the deep neuromuscular blockade group, rocuronium administration was adjusted such that the train-of-four count was zero with a posttetanic count 2 or less.. The primary outcome was the volume of intra-operative surgical bleeding. The surgeon's satisfaction with operating conditions, haemodynamic and respiratory status, and postoperative pain scores were evaluated.. The median [IQR] volume of intra-operative surgical bleeding was significantly less in the deep neuromuscular blockade group than in the moderate neuromuscular blockade group; 300 ml [200 to 494] vs. 415 ml [240 to 601]; difference: 117 ml (95% CI, 9 to 244; P = 0.044). The mean ± SD surgeon's satisfaction with the intra-operative surgical conditions was greater in the deep neuromuscular blockade group than in the moderate neuromuscular blockade group; 3.5 ± 1.0 vs. 2.9 ± 0.9 (P = 0.004). In intergroup comparisons of respiratory variables, peak inspiratory pressure was lower in the deep neuromuscular blockade group overall (P < 0.001). The median [IQR] postoperative pain score was lower in the deep neuromuscular blockade group than the moderate neuromuscular blockade group; 50 [36 to 60] vs. 60 [50 to 70], (P = 0.023).. Deep neuromuscular blockade reduced intra-operative surgical bleeding in patients undergoing spinal surgery. This may be related to greater relaxation in the back muscles and lower intra-operative peak inspiratory pressure when compared with moderate neuromuscular blockade.. KCT0001264 (http://cris.nih.go.kr).

Topics: Anesthetics; Blood Loss, Surgical; Humans; Neuromuscular Blockade; Pain, Postoperative; Rocuronium

It remains unclear whether deep neuromuscular blockade results in better postoperative recovery than does moderate neuromuscular blockade. Therefore, in this study, we aimed to compare the effects of deep neuromuscular blockade and moderate neuromuscular blockade on the quality of postoperative recovery in patients undergoing robotic gastrectomy.. In this prospective, double-blind, single-center randomized controlled superiority trial with two parallel groups, 56 adult patients (19-80 years) scheduled for elective robotic gastrectomy were randomly assigned to a moderate neuromuscular blockade group or a deep neuromuscular blockade group in a 1:1 ratio. In the deep and moderate neuromuscular blockade groups, the infusion rate for rocuronium was adjusted to maintain a post-tetanic count of 1-2 or a train-of-four count of 1-2, respectively. The primary outcome was the Quality of Recovery-40 (QoR-40) score on postoperative day 1. Secondary outcomes included the QoR-40 score on postoperative day 2, intraoperative hemodynamic data, intraoperative respiratory data, visual analog scale score for pain, postoperative incidences of nausea and vomiting, postoperative rescue analgesic use, and postoperative rescue antiemetic use.. The postoperative QoR-40 score was similar between the two groups on postoperative days 1 and 2. Moreover, the two groups showed no differences in intraoperative hemodynamic and respiratory data or postoperative pain, nausea and vomiting, and rescue medication use.. Our findings suggest that the quality of recovery after robotic gastrectomy is similar for deep and moderate neuromuscular blockade. Therefore, deep neuromuscular blockade during robotic gastrectomy may be unnecessary, at least in patients with normal body mass index.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia Recovery Period; Double-Blind Method; Female; Gastrectomy; Hemodynamics; Humans; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Postoperative Period; Prospective Studies; Respiratory Mechanics; Robotic Surgical Procedures; Rocuronium; Treatment Outcome; Young Adult

To evaluate the influence of reversal of neuromuscular blockade with sugammadex or neostigmine on postoperative quality of recovery following a single bolus dose of rocuronium after pars plana vitrectomy (PPV) under general anesthesia.. Prospective, double-blind, randomized controlled trial.. This study was conducted in a University Teaching Hospital from February to July 2017.. A total of 84 patients with an American Society of Anesthesiologists physical status of I or II who were scheduled to undergo PPV under general anesthesia.. The patients were randomly assigned to the neostigmine (Group N, n = 44) or sugammadex (Group S, n = 40) groups; 3 ml of study drug was prepared for the patients. For patients in Group N, a solution of neostigmine methylsulfate (1 mg) and glycopyrrolate (0.2 mg) was prepared, while a solution of sugammadex sodium (2 mg/kg) and normal saline was prepared for patients in Group S.. The primary endpoint was the effect of sugammadex, compared with neostigmine, on the recovery rate in the physiological domain in patients who underwent PPV with general anesthesia. The quality of recovery was assessed using the Postoperative Quality Recovery Scale at 15 min and 40 min after surgery, and on postoperative day 1.. The recovery rate in the physiological domain was higher in Group S at 15 min after surgery (P = 0.020). Though there were no significant differences in the overall cognitive recovery domain, patients in Group S could recall more numbers in reverse order. However, there were no significant differences between the groups in the other domains of the scale.. The use of sugammadex may increase the quality of physiological recovery at early postoperative periods, compared with that of neostigmine, following a single bolus dose of rocuronium in patients undergoing PPV with general anesthesia.. Registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03108989). Registration number: NCT03108989.

Topics: Aged; Anesthesia Recovery Period; Anesthesia, General; Double-Blind Method; Female; Humans; Male; Middle Aged; Neostigmine; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Postoperative Cognitive Complications; Prospective Studies; Rocuronium; Sugammadex; Vitrectomy

Higher intra-abdominal pressure may impair cardiopulmonary functions during laparoscopic surgery. While 12-15 mmHg is generally recommended as a standard pressure, the benefits of lower intra-abdominal pressure are unclear. We thus studied whether the low intra-abdominal pressure compared with the standard pressure improves cardiopulmonary dynamics during laparoscopic surgery.. Patients were randomized according to the intra-abdominal pressure and neuromuscular blocking levels during laparoscopic colorectal surgery: low pressure (8 mmHg) with deep-block (post-tetanic count 1-2), standard pressure (12 mmHg) with deep-block, and standard pressure with moderate-block (train-of-four count 1-2) groups. During the laparoscopic procedure, we recorded cardiopulmonary variables including cardiac index, pulmonary compliance, and surgical conditions. We also assessed postoperative pain intensity and recovery time of bowel movement. The primary outcome was the cardiac index 30 min after onset of laparoscopy.. Patients were included in the low pressure with deep-block (n = 44), standard pressure with deep-block (n = 44), and standard pressure with moderate-block (n = 43) groups. The mean (SD) of cardiac index 30 min after laparoscopy was 2.7 (0.7), 2.7 (0.9), and 2.6 (1.0) L min. We observed few cardiopulmonary benefits but poor surgical conditions in the low intra-abdominal pressure during laparoscopy. Considering cardiopulmonary dynamics and surgical conditions, the standard intra-abdominal pressure may be preferable to the low pressure for laparoscopic surgery.

Topics: Abdominal Cavity; Colorectal Surgery; Digestive System Surgical Procedures; Double-Blind Method; Female; Heart Function Tests; Humans; Laparoscopy; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Outcome Assessment, Health Care; Pain, Postoperative; Pressure; Respiratory Function Tests; Rocuronium

Intraoperative neuromuscular blocker is widely used, but is known to be associated with postoperative residual paralysis, which is known to be associated with increased risk of pulmonary complications. Hence, its use should be individualized and restricted to procedures where it is mandatory. We examined whether not using a neuromuscular blocker affects the surgical conditions in children undergoing inguinal herniorrhaphy.. Anesthesia was induced and maintained with sevoflurane in 60% nitrous oxide, and the airway was maintained using an I-gel. In total, 66 children aged 1 to 6 years were randomized to receive rocuronium (rocuronium group, n = 33) or saline (control group, n = 33); 61 children of them finished the study. A single surgeon who performed the operation rated the surgical condition of each patient on a 4-point scale (1 = poor, 2 = acceptable, 3 = good, and 4 = excellent). Intraoperative patient movement, recovery time, emergence agitation, and postoperative pain scores were evaluated.. One patient in control group and no patient in rocuronium group showed intraoperative movement. When noninferiority test was done for intraoperative patient movement, with the noninferiority margin of 20%, the difference of absolute risk was 3.3% (95% confidence interval -8.0% to 16.7%) and saline group was noninferior to rocuronium group. All of the patients showed good to excellent surgical conditions, and no difference was found between the 2 groups. The recovery time was shorter in the control group than in the rocuronium group (4.5 ± 1.8 vs 5.6 ± 2.2 minutes, respectively; P = .028).. In children aged 1 to 6 years undergoing inguinal herniorhaphy under sevoflurane anesthesia using an I-gel, not using neuromuscular blocker showed similar intraoperative condition and shortened recovery time compared with using neuromouscular blocker.

Topics: Androstanols; Anesthetics, Inhalation; Child; Child, Preschool; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Infant; Male; Methyl Ethers; Movement; Neuromuscular Blockade; Neuromuscular Blocking Agents; Pain, Postoperative; Recovery of Function; Rocuronium; Sevoflurane; Time Factors; Treatment Outcome

Ionised calcium plays an important role in neuromuscular transmission, but its effects on the reversal of nondepolarising neuromuscular blockade have not been fully evaluated.. We examined whether calcium chloride coadministered with neostigmine could enhance the rate of neuromuscular recovery.. Randomised double-blind trial.. A tertiary teaching hospital.. In total, 53 patients undergoing elective surgery under general anaesthesia with neuromuscular monitoring by acceleromyography using a TOF-Watch SX monitor.. Patients were randomly allocated to receive either 5 mg kg of calcium chloride (calcium group, n = 26) or the same volume of normal saline (control group, n = 27) coadministered with 25 μg kg of neostigmine and 15 μg kg of atropine at the end of surgery.. The primary end point was the neuromuscular recovery time [time from neostigmine administration to recovery of the TOF ratio (TOFr) to 0.9]. Secondary end points included the TOFr at 5, 10 and 20 min after neostigmine administration and the incidence of postoperative residual curarisation (PORC), defined as a TOFr less than 0.9 at each time point.. The neuromuscular recovery time was significantly faster in the calcium group than in the control group (median [Q1 to Q3]; 5.0 [3.0 to 7.0] vs. 6.7 [5.7 to 10.0] min, respectively; P = 0.007). At 5 min after neostigmine administration, the TOFr was higher [87 (74 to 100) vs. 68 (51 to 81)%, respectively; P = 0.002] and the incidence of PORC was lower (50.0 vs. 81.5%, respectively; P = 0.016) in the calcium group than in the control group. There were no differences between the two groups with respect to the TOFr or incidence of PORC at 10 and 20 min after neostigmine administration.. Calcium chloride coadministered with neostigmine enhanced neuromuscular recovery in the early period of nondepolarising neuromuscular blockade reversal.

Topics: Adult; Aged; Anesthesia, General; Calcium Chloride; Cholinesterase Inhibitors; Delayed Emergence from Anesthesia; Double-Blind Method; Elective Surgical Procedures; Female; Humans; Incidence; Male; Middle Aged; Neostigmine; Neuromuscular Blockade; Neuromuscular Monitoring; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Rocuronium; Time Factors; Treatment Outcome

Carbon dioxide (CO2) absorption and increased intra-abdominal pressure can adversely affect perioperative physiology and postoperative recovery. Deep muscle relaxation is known to improve the surgical conditions during laparoscopic surgery. We aimed to compare the effects of deep and moderate neuromuscular block in laparoscopic colorectal surgery, including intra-abdominal pressure. In this prospective, double-blind, parallel-group trial, 72 adult patients undergoing laparoscopic colorectal surgery were randomized using an online randomization generator to achieve either moderate (1-2 train-of-four response, n = 36) or deep (1-2 post-tetanic count, n = 36) neuromuscular block by receiving a continuous infusion of rocuronium. Adjusted intra-abdominal pressure, which was titrated by a surgeon with maintaining the operative field during pneumoperitoneum, was recorded at 5-minute intervals. Perioperative hemodynamic parameters and postoperative outcomes were assessed. Six patients from the deep and 5 from the moderate neuromuscular block group were excluded, leaving 61 for analysis. The average adjusted IAP was lower in the deep compared to the moderate neuromuscular block group (9.3 vs 12 mm Hg, P < 0.001). The postoperative pain scores (P < 0.001) and incidence of postoperative shoulder tip pain were lower, whereas gas passing time (P = 0.002) and sips of water time (P = 0.005) were shorter in the deep neuromuscular block than in the moderate neuromuscular block group. Deep neuromuscular blocking showed several benefits compared to conventional moderate neuromuscular block, including a greater intra-abdominal pressure lowering effect, whereas surgical conditions are maintained, less severe postoperative pain and faster bowel function recovery.

Topics: Androstanols; Blood Loss, Surgical; Colorectal Surgery; Double-Blind Method; Female; Humans; Laparoscopy; Male; Middle Aged; Neuromuscular Blockade; Pain, Postoperative; Pneumoperitoneum, Artificial; Prospective Studies; Rocuronium

The degree of neuromuscular blockade is one of the important factors that determine the condition of surgical space during laparoscopic surgery. Magnesium sulfate potentiates the actions of neuromuscular blocking agent, and we hypothesized that intraoperative magnesium sulfate infusion may improve surgical space condition during laparoscopic surgery.. Eighty-four patients undergoing elective laparoscopic gastrectomy were randomized to receive isotonic saline (group C) or magnesium sulfate (group M, loading dose with 50 mg/kg over 10 min and then 15 mg/kg/h by continuous infusion) to maintain the moderate neuromuscular blockade using rocuronium. Two experienced surgeons scored the quality of surgical space condition using a 5-point surgical rating scale (SRS). The secondary outcomes included recovery profiles, postoperative pain and adverse events.. The SRS in group M was higher than that of group C. The proportion of patients with a SRS of 5 (optimal) was 2.7 % in the group C and 40.5 % in the group M (P < 0.0001) although a lower amount of rocuronium was required in group M than group C [24.2 (6.5) mg/h for group M vs. 27.5 (6) mg/h for group C; P = 0.017]. Pain after operation site was less severe in group M than in group C at postoperative 24 h (P = 0.009). Recovery profiles and adverse events were similar between the two groups.. Intraoperative administration of magnesium sulfate improved the quality of surgical space conditions and decreased neuromuscular blocking agent requirement and postoperative pain in patients undergoing laparoscopic gastrectomy.

Topics: Androstanols; Double-Blind Method; Female; Gastrectomy; Humans; Intraoperative Care; Laparoscopy; Magnesium Sulfate; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Blocking Agents; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pneumoperitoneum, Artificial; Prospective Studies; Rocuronium

Rocuronium for cesarean delivery under general anesthesia is an alternative to succinylcholine for rapid-sequence induction of anesthesia because of the availability of sugammadex for reversal of neuromuscular blockade. However, there are no large well-controlled studies in women undergoing general anesthesia for cesarean delivery. The aim of this noninferiority trial was to determine whether rocuronium and sugammadex confer benefit in time to tracheal intubation (primary outcome) and other neuromuscular blockade outcomes compared with succinylcholine, rocuronium, and neostigmine in women undergoing general anesthesia for cesarean delivery.. We aimed to enroll all women undergoing general anesthesia for cesarean delivery in the 2 participating university hospitals (Brno, Olomouc, Czech Republic) in this single-blinded, randomized, controlled study. Women were randomly assigned to the ROC group (muscle relaxation induced with rocuronium 1 mg/kg and reversed with sugammadex 2-4 mg/kg) or the SUX group (succinylcholine 1 mg/kg for induction, rocuronium 0.3 mg/kg for maintenance, and neostigmine 0.03 mg/kg for reversal of the neuromuscular blockade). The interval from the end of propofol administration to tracheal intubation was the primary end point with a noninferiority margin of 20 seconds. We recorded intubating conditions (modified Viby-Mogensen score), neonatal outcome (Apgar score <7; umbilical artery pH), anesthesia complications, and subjective patient complaints 24 hours after surgery.. We enrolled 240 parturients. The mean time to tracheal intubation was 2.9 seconds longer in the ROC group (95% confidence interval, -5.3 to 11.2 seconds), noninferior compared with the SUX group. Absence of laryngoscopy resistance was greater in the ROC than in the SUX groups (ROC, 87.5%; SUX, 74.2%; P = 0.019), but there were no differences in vocal cord position (P = 0.45) or intubation response (P = 0.31) between groups. No statistically significant differences in incidence of anesthesia complications or in neonatal outcome were found (10-minute Apgar score <7, P = 0.07; umbilical artery pH, P = 0.43). The incidence of postpartum myalgia was greater in the SUX group (ROC 0%; SUX 6.7%; P = 0.007). The incidence of subjective complaints was lower in the ROC group (ROC, 21.4%; SUX, 37.5%; P = 0.007).. We conclude that rocuronium for rapid-sequence induction is noninferior for time to tracheal intubation and is accompanied by more frequent absence of laryngoscopy resistance and lower incidence of myalgia in comparison with succinylcholine for cesarean delivery under general anesthesia.

Topics: Adolescent; Adult; Androstanols; Anesthesia, General; Anesthesia, Obstetrical; Antidotes; Cesarean Section; Cholinesterase Inhibitors; Czech Republic; Female; gamma-Cyclodextrins; Humans; Intubation, Intratracheal; Laryngoscopy; Middle Aged; Myalgia; Neostigmine; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pregnancy; Rocuronium; Single-Blind Method; Succinylcholine; Sugammadex; Time Factors; Treatment Outcome; Young Adult

Few data are available on TAP block in laparoscopic colorectal surgery and ERAS program. The aim of this prospective study was to evaluate local wound infiltration plus TAP block compared to local wound infiltration in the management of postoperative pain, nausea and vomiting, ileus and use of opioids in the context of laparoscopic colorectal surgery and ERAS program.. From March 2014 to March 2015, 48 patients were treated by laparoscopic resection and ERAS program for colorectal cancer and diverticular disease at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust. Among these, 24 patients received local wound infiltration plus TAP block (TAP block group) and 24 patients received local wound infiltration (control group).. No differences were observed in baseline patient characteristics, clinical variables and surgical procedures between the two groups. Local wound infiltration plus TAP block allowed to achieve pain control despite a reduced use of opioid analgesics (P = 0.009). The adoption of TAP block resulted beneficial on the prevention of postoperative nausea (P = 0.002) and improvement of essential outcomes of ERAS program as recovery of bowel function (P = 0.005), urinary catheter removal (P = 0.003) and capability to tolerate oral diet (P = 0.027).. TAP block plus local wound infiltration in the setting of laparoscopic colorectal surgery and ERAS program guarantees a reduced use of opioid analgesics and good pain control allowing the improvement of essential items of enhanced recovery pathways.

Topics: Abdominal Muscles; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Anesthetics, Local; Colectomy; Female; Humans; Laparoscopy; Male; Middle Aged; Nerve Block; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Postoperative Nausea and Vomiting; Prospective Studies; Rectum; Rocuronium

This study aimed to determine whether muscle relaxants facilitates insertion efficacy of the i-gel supraglottic device (i-gel) by novice doctors in anesthetized patients.. Randomized clinical trial.. Operating room.. Seventy adult patients scheduled for elective surgery under general anesthesia.. Seventy adult patients were assigned to the rocuronium (MR group; 35 patients) or control group (C group; 35 patients). Anesthesia was induced with propofol and remifentanil, and 0.9mgkg(-1) rocuronium was administered in the MR group.. The number of attempts to successful insertion, sealing pressure, and subjective difficulty of insertion were compared between the groups.. The total number of insertion attempts were as follows: one (MR group, 17 cases; C group, 4 cases), two (MR group, 13 cases; C group, 14 cases), three (MR group, 4 cases; C group, 14 cases), and failure (MR group, 1 case; C group, 3 cases), which was significantly different (P<.001). Sealing pressure was significantly higher in the MR group than in the C group (MR group, 22.1±5.4 cmH2O; C group, 18.7±3.2 cmH2O, P<.001). Subjective difficulty of insertion was significantly lower in the MR group than in the C group (C group, 72.4±19.0mm; MR group, 29.4±18.3mm; P<.001).. Our randomized clinical trial suggests that muscle relaxation facilitates i-gel insertion efficacy in anesthetized patients, as assessed by successful insertion rate, sealing pressure, and subjective difficulty of insertion.

Topics: Adult; Aged; Aged, 80 and over; Airway Management; Androstanols; Anesthesia, Intravenous; Anesthesiologists; Anesthetics, Intravenous; Clinical Competence; Female; Hoarseness; Humans; Intubation, Intratracheal; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Piperidines; Postoperative Complications; Propofol; Prospective Studies; Remifentanil; Respiration, Artificial; Rocuronium; Young Adult

Surgical conditions in laparoscopic surgery are largely determined by the depth of neuromuscular relaxation. Especially in procedures that are confined to a narrow working field, such as retroperitoneal laparoscopic surgery, deep neuromuscular relaxation may be beneficial. Until recently, though, deep neuromuscular block (NMB) came at the expense of a variety of issues that conflicted with its use. However, with the introduction of sugammadex, rapid reversal of a deep NMB is feasible. In the current protocol, the association between the depth of NMB and rating of surgical conditions by the surgeon and anesthesiologist is studied.. This is a single-center, prospective, randomized, blinded, parallel group and controlled trial. Eligible patients are randomly assigned to one of two groups: (1) deep NMB (post-tetanic count, one or two twitches; n = 12) and (2) moderate NMB (train-of-four, 1 to 2 twitches, n = 12) by administration of high-dose rocuronium in Group 1 and a combination of atracurium and mivacurium in Group 2. The NMB in Group 1 is reversed by 4 mg/kg sugammadex; the NMB in Group 2 by 1 mg neostigmine and 0.5 mg atropine. Patients are eligible if they are over 18 years, willing to sign the informed consent form, and are scheduled to undergo an elective laparoscopic renal procedure or laparoscopic prostatectomy. A single surgeon performs the surgeries and rates the surgical conditions on a five-point surgical rating scale (SRS) ranging from 1 (poor surgical conditions) to 5 (excellent surgical conditions). The intra-abdominal part of the surgeries is captured on video and a group of five anesthesiologists and ten surgical experts will rate the videos using the same SRS. The primary analysis will be an intention-to-treat analysis. Evaluation will include the association between the level of NMB and SRS, as obtained by the surgeon performing the procedure and the agreement between the scoring of the images by anesthesiologists and surgeons.. We aim to show that under the right conditions the perceived opposing goals of surgeons and anesthesiologists (optimal surgical conditions vs. optimal postoperative conditions) may be met without compromise to either.. ClinicalTrials.gov identifier NCT01631149.

Topics: Academic Medical Centers; Androstanols; Anesthesia Department, Hospital; Atracurium; Atropine; Attitude of Health Personnel; Clinical Protocols; Female; gamma-Cyclodextrins; Health Knowledge, Attitudes, Practice; Humans; Intention to Treat Analysis; Isoquinolines; Kidney; Laparoscopy; Male; Medical Staff, Hospital; Mivacurium; Neostigmine; Netherlands; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Perception; Prospective Studies; Prostatectomy; Research Design; Rocuronium; Sugammadex; Surgery Department, Hospital; Task Performance and Analysis; Treatment Outcome; Video Recording

Laparoscopic cholecystectomy (LC) can be performed using low intra-abdominal pressure (< 12 mmHg), but surgical conditions may not be optimal. The present study aimed at comparing surgical space conditions using either deep, continuous muscle relaxation or moderate blockade during low-pressure (8 mmHg) LC. We hypothesized that a deep neuromuscular block would be associated with a higher proportion of optimal surgical space conditions.. This was an investigator-initiated, patient- and assessor-blinded study. Up to 72 patients scheduled for elective LC were randomised to either deep neuromuscular blockade (post-tetanic count 0-1) or moderate neuromuscular blockade, where at least one response to train-of-four nerve stimulation was present. The primary outcome was surgical space conditions at the time during surgery when conditions were worst. The secondary outcomes included the proportion of procedures completed at pneumoperitoneum 8 mmHg, post-operative pain, and incidence of nausea and vomiting.. This study was the first randomised study to assess the association between depth of neuromuscular blockade and surgical space conditions during low-pressure LC. The study findings may be applicable to a general surgical population undergoing LC.. The University of Copenhagen, Denmark and Sophus Johansens Foundation of 1981, Denmark funded this study, which was also financed by a research grant from the Investigator Initiated Studies Program of Merck Sharp and Dohme Corp.. NCT 01523886.

Topics: Adult; Androstanols; Cholecystectomy, Laparoscopic; Double-Blind Method; Humans; Insufflation; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Postoperative Nausea and Vomiting; Pressure; Research Design; Rocuronium; Young Adult

Cranial electrotherapy stimulation (CES) is used as a treatment for depression and anxiety, and as an adjunctive intervention for pain management. This prospective study investigated whether CES could decrease preoperative anxiety, the injection pain of rocuronium, postoperative pain and stress hormone levels.. Female patients undergoing thyroidectomy were randomly assigned to two groups, to receive either no pretreatment (control group) or CES pretreatment. Anxiety score, withdrawal response on rocuronium injection, and pain scores at 1, 4, 12 and 24 h post surgery were evaluated. Adrenocorticotrophic hormone (ACTH), cortisol and glucose levels were measured. Patients were blinded to the treatment condition.. Fifty patients entered the study (n = 25 per group). Anxiety score and withdrawal responses during rocuronium injection were significantly reduced in the CES group compared with the control group. Pain score was significantly lower in the CES group than in the control group, 1 h and 4 h post surgery. There were no significant differences in ACTH, cortisol and glucose levels.. CES pretreatment appears to reduce the level of preoperative anxiety, injection pain of rocuronium and postoperative pain. However, CES pretreatment did not affect stress hormone responses.

Topics: Adrenocorticotropic Hormone; Adult; Aged; Androstanols; Anxiety; Blood Glucose; Electric Stimulation Therapy; Endocrine System; Female; Humans; Hydrocortisone; Middle Aged; Pain Management; Pain Measurement; Pain, Postoperative; Rocuronium; Skull; Thyroidectomy; Treatment Outcome; Young Adult

Remifentanil is known to cause bradycardia and hypotension, as well as the decreases of cardiac output (CO). We hypothesized that hemodynamic suppression by remifentanil would affect the onset time of rocuronium. This study investigated whether the onset of rocuronium was influenced by the drug-administration sequence during induction of anesthesia with target-controlled infusion of propofol and remifentanil.. Healthy adult patients (n = 126) undergoing elective surgery under general anesthesia were randomized into two groups according to drug-administration sequence. In Remi-Pro-Rocu group (n = 62), remifentanil was infused first, followed by propofol. Then, rocuronium was administered lastly. In Pro-Rocu-Remi group (n = 64), propofol, rocuronium, and remifentanil were given in that order. As a primary outcome, the onset time of rocuronium was measured. Mean arterial pressure (MAP), heart rate (HR), CO, and stroke volume were recorded before anesthesia (T1), at injection of rocuronium (T2), immediately before and after intubation (T3 and T4).. In Remi-Pro-Roc group, the onset of rocuronium was delayed significantly compared with Pro-Rocu-Remi group [median (interquartile range); 130 (105-150) vs. 90 (71-100) s, P < 0.001]. At the time of rocuronium injection (T2), MAP, HR, and CO were significantly lower in Remi-Pro-Rocu group than Pro-Rocu-Remi group (P < 0.001).. The onset time of rocuronium is prolonged significantly by early administration of remifentanil during target-controlled infusion of propofol and remifentanil, and it may be due to the decreased CO caused by remifentanil.

Topics: Adult; Androstanols; Anesthetics, Intravenous; Blood Pressure; Cardiac Output; Double-Blind Method; Drug Interactions; Female; Hemodynamics; Humans; Male; Middle Aged; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Piperidines; Propofol; Remifentanil; Rocuronium; Sample Size; Stroke Volume; Time Factors; Treatment Outcome

The purpose of this study is to investigate the suitability of dexmedetomidine as a helpful sedative agent in direct laryngoscopic biopsy (DLB), under total intravenous anesthesia (TIVA).. In this double blind randomised study, patients were allocated to receive dexmedetomidine 0.5 microg/kg (group D, n = 20) or saline placebo (group P, n = 20) intravenously. Forty ASA I-III patients were infused propofol and administered rocuronium bromur. They were intubated and performed biopsy. Aldrete scores, intraoperative propofol and postoperative analgesic requirements, satisfaction scores, recovery time, Ramsay sedation scale (RSS), haemodynamic changes and side effects were recorded.. Postoperative analgesic requirement in group D was significantly lower and satisfaction scores and RSS were significantly higher than in group P. Additionally, MAP (mean arterial blood pressure) significantly decreased at post-extubation time in group D.. The premedication with a single dose of dexmedetomidine decreases intraoperative propofol and postoperative analgesic requirements, increases the postoperative satisfaction and RSS considerably in patients undergoing DLB under TIVA.

Topics: Adult; Aged; Analgesics; Androstanols; Anesthesia, Intravenous; Biopsy; Blood Pressure; Dexmedetomidine; Double-Blind Method; Female; Humans; Hypnotics and Sedatives; Laryngeal Neoplasms; Laryngoscopy; Male; Middle Aged; Pain, Postoperative; Propofol; Rocuronium

In this double-blind, randomized, placebo-controlled study, we evaluated the effects of magnesium sulphate on neuromuscular blocking agent requirements and analgesia in children with cerebral palsy (CP).. We randomly divided 61 children with CP undergoing orthopaedic surgery into two groups. The magnesium group (Group M) received magnesium sulphate 50 mg kg(-1) i.v. as a bolus and 15 mg kg(-1) h(-1) by continuous infusion during the operation. The control group (Group S) received the same amount of isotonic saline. Rocuronium was administered 0.6 mg kg(-1) before intubation and 0.1 mg kg(-1) additionally when train-of-four counts were 2 or more. I.V. fentanyl and ketorolac were used to control postoperative pain. Total infused analgesic volumes and pain scores were evaluated at postoperative 30 min, and at 6, 24, and 48 h.. The rocuronium requirement of Group M was significantly less than that of Group S [0.29 (0.12) vs 0.42 (0.16) mg kg(-1) h(-1), P<0.05]. Cumulative analgesic consumption in Group M was significantly less after operation at 24 and 48 h (P<0.05), and pain scores in Group M were lower than in Group S during the entire postoperative period (P<0.05). Serum magnesium concentrations in Group M were higher until 24 h after operation (P<0.05). The incidence of postoperative nausea and vomiting and rescue drug injections was similar in the two groups. No shivering or adverse effects related to hypermagnesaemia were encountered.. I.V. magnesium sulphate reduces rocuronium requirements and postoperative analgesic consumption in children with CP.

Topics: Adolescent; Analgesics; Analgesics, Opioid; Androstanols; Cerebral Palsy; Child; Child, Preschool; Double-Blind Method; Drug Administration Schedule; Drug Synergism; Female; Humans; Intraoperative Care; Magnesium Sulfate; Male; Neuromuscular Nondepolarizing Agents; Osteotomy; Pain Measurement; Pain, Postoperative; 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

In this study, we examined the effect of choice of neuromuscular blocking drug (NMBD) (pancuronium versus rocuronium) on postoperative recovery times and associated adverse outcomes in patients undergoing orthopedic surgical procedures. Seventy patients were randomly allocated to a pancuronium or rocuronium group. On arrival to the postanesthesia care unit (PACU) and again 30 min later, train-of-four ratios were quantified by using acceleromyography. Immediately after acceleromyographic measurements, patients were assessed for signs and symptoms of residual paresis. During the PACU admission, episodes of hypoxemia, nausea, and vomiting were recorded. The time required for patients to meet discharge criteria and the time of actual PACU discharge were noted. Forty percent of patients in the pancuronium group had train-of-four ratios <0.7 on arrival to the PACU, compared with only 5.9% of subjects in the rocuronium group (P < 0.001). Patients in the pancuronium group were more likely to experience symptoms of muscle weakness (blurry vision and generalized weakness; P < 0.001) and hypoxemia (10 patients in the rocuronium group versus 21 patients in the pancuronium group; P = 0.015) during the PACU admission. Significant delays in meeting PACU discharge criteria (50 min [45-60 min] versus 30 min [25-40 min]) and achieving actual discharge (70 min [60-90 min] versus 57.5 min [45-61 min]) were observed when the pancuronium group was compared with the rocuronium group (P < 0.001). In conclusion, our study indicates that PACU recovery times may be prolonged when long-acting NMBDs are used in surgical patients.. Clinical recovery may be delayed in surgical patients administered long-acting neuromuscular blocking drugs. During the postanesthesia care unit admission, patients randomized to receive pancuronium (versus rocuronium) were more likely to exhibit symptoms of muscle weakness, develop hypoxemia, and require more time to meet discharge criteria.

Topics: Adult; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Double-Blind Method; Female; Humans; Hypoxia; Male; Middle Aged; Monitoring, Intraoperative; Muscle Weakness; Neuromuscular Blocking Agents; Neuromuscular Nondepolarizing Agents; Orthopedic Procedures; Oxygen Inhalation Therapy; Pain Measurement; Pain, Postoperative; Pancuronium; Postoperative Complications; Postoperative Nausea and Vomiting; Rocuronium

The incidence of postoperative myalgia (POM) after succinylcholine administration has been reported to range from 5% to 83%. The administration of small doses of nondepolarizing muscle relaxants or lidocaine before the administration of succinylcholine has been shown to decrease the incidence and severity of POM experienced by patients. The purpose of this investigation was to compare the severity of POM in subjects receiving pretreatment with rocuronium or lidocaine. Seventy-four subjects were enrolled in this randomized, double-blind investigation to measure the effect of pretreatment modalities on the incidence and severity of myalgia following succinylcholine administration. Pretreatment consisted of either lidocaine, 1.5 mg/kg, or rocuronium, 0.03 mg/kg. Myalgia was measured using a 4-point ordinal scale. Ordinal and nominal data were analyzed using a chi 2 test and the Fisher exact test. A P value of less than .05 was considered significant. Data for 53 subjects were included in the analysis. Of the lidocaine group, 21 (72%) of 29 reported no myalgia at 48 hours compared with only 9 (38%) of 24 in the rocuronium group (P = 0.023). Satisfaction was similar between the groups. Based on the results of this study, pretreatment with lidocaine may provide better relief from myalgia than rocuronium at 48 hours after surgery.

Topics: Adolescent; Adult; Aged; Androstanols; Anesthetics, Local; Drug Therapy, Combination; Female; Humans; Incidence; Lidocaine; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Rocuronium; Severity of Illness Index; Succinylcholine

Topics: Adolescent; Adult; Aged; Androstanols; Anesthesia, General; Double-Blind Method; Fasciculation; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Rocuronium; Succinylcholine; Tubocurarine

We compared d-tubocurarine and rocuronium for the prevention of succinylcholine-induced fasciculations and postoperative myalgia (POM) and evaluated the influence of both drugs on the speed of onset and recovery of succinylcholine.. Seventy-five women undergoing surgery of short duration were studied. They were randomized to one of three groups: group SAL received normal saline followed three minutes later by 1.0 mg.kg-1 succinylcholine; group ROC received 0.05 mg.kg-1 rocuronium + 1.5 mg.kg-1 succinylcholine; group DTC received 0.05 mg.kg-1 d-tubocurarine + 1.5 mg.kg-1 succinylcholine. Single-twitch stimulation was applied to the ulnar nerve every 10 sec and the EMG response of the adductor pollicis was recorded. Fasciculations were assessed by a blinded observer on a scale of 0-3. Patients were asked 24 and 48 hr later to rate POM using a scale of 0-10.. The interval needed for twitch height to decrease to 10% of initial value after succinylcholine was longer in group ROC (58 +/- 20 sec) (mean +/- SD) compared with group SAL (44 +/- 13 sec) (P < 0.05). Recovery to 20% occurred faster in group ROC (324 +/- 83 sec) than in groups SAL (456 +/- 103 sec) and DTC (450 +/-132 sec) (P < 0.05). Fasciculations were more intense in groups SAL than in groups ROC and DTC (P < 0.001). Patients rated POM as less intense 24hr postoperatively only in group ROC (1.2 +/- 2.4) compared with group SAL (3.3 +/- 3.5) (P < 0.05).. Rocuronium prevents succinylcholine-induced fasciculations and POM. Rocuronium also delays the onset of succinylcholine and shortens its duration compared with d-tubocurarine.

Topics: Adolescent; Adult; Androstanols; Anesthesia, General; Electric Stimulation; Electromyography; Fasciculation; Female; Humans; Middle Aged; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Rocuronium; Succinylcholine; Time Factors; 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

Topics: Anesthesia, Epidural; Anesthesia, Inhalation; Child, Preschool; Contrast Media; Digestive System Abnormalities; Female; Fontan Procedure; Heart Defects, Congenital; Heterotaxy Syndrome; Humans; Intestinal Volvulus; Neuromuscular Blockade; Pain, Postoperative; Rocuronium; Sevoflurane; Tomography, X-Ray Computed; Treatment Outcome

Topics: Abdominal Pain; Adolescent; Anaphylaxis; Anesthesia, Dental; Drug Hypersensitivity; Ephedrine; Epinephrine; Female; Humans; Molar, Third; Pain, Postoperative; Postoperative Period; Rocuronium; Severity of Illness Index; Sugammadex; Tooth Extraction

Recent data shows that a neuromuscular block (NMB) induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% vs. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12-0.95). This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our findings and additionally assess the pharmacoeconomics of high-dose relaxant anesthesia taking into account the benefits (reduced readmissions) and harm (cost of relaxants and reversal agents) of such practice.

Topics: Androstanols; Dose-Response Relationship, Drug; Female; Humans; Laparoscopy; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Patient Readmission; Retroperitoneal Space; Retrospective Studies; Rocuronium

We present the case of an 8‑year-old female child with suspected peroxisomal disorder requiring general anesthesia for adenotomy, paracentesis and brainstem-evoked response audiometry. Peroxisomes are small intracellular organelles that catalyse key metabolic reactions. Peroxisomal disorders are a heterogeneous group of rare genetic diseases. Anesthesia can be challenging as adrenal insufficiency, mental retardation, muscle weakness, risk of pulmonary aspiration, airway complications, seizure disorders and altered pharmacokinetics and pharmacodynamics can occur in these patients but guidelines for anesthesia do not exist due to the heterogeneity and rarity of these diseases and case reports are rare. Anesthesia was induced by sevoflurane via a face mask, followed by remifentanil and rocuronium for oral intubation after intravenous access was obtained. Anesthesia was maintained with sevoflurane and remifentanil. Dexamethasone was given for prophylaxis of postoperative nausea and vomiting as well as perioperative adrenal crises. Piritramide was given for postoperative analgesia. With this approach anesthesia was uneventful. The trachea was extubated with the patient awake and she was taken to the recovery room in a stable condition. The classification and breadth of clinical manifestations of peroxisomal disorders is complex and briefly summarized. Anesthesiologists should consider characteristics of their particular patient's form of peroxisomal disorder, as this may greatly influence procedural planning.

Topics: Airway Extubation; Analgesics, Opioid; Androstanols; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Antiemetics; Child; Dexamethasone; Female; Humans; Methyl Ethers; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Peroxisomal Disorders; Piperidines; Pirinitramide; Postoperative Nausea and Vomiting; Remifentanil; Rocuronium; Sevoflurane

The importance of anesthetic technique is often underappreciated in face-lift procedures and is sparsely written about in the literature. Appropriate control of blood pressure, anxiety, pain, and nausea is essential for reducing the complications of face lift, primarily, hematoma risk. This study discusses the standard anesthetic protocol provided at the authors' institution and describes the preoperative, intraoperative, and postoperative management of face-lift patients resulting in low hematoma and complication rates.. One thousand eighty-nine patients who underwent face-lift procedures performed by a single surgeon (R.J.R) were included in a retrospective chart review following institutional review board approval. Patient demographics, operative data including additional ancillary procedures, and the anesthesia regimen were recorded. In addition, postoperative complications and reoperation rates were documented.. Between 1990 and 2013, 1089 face-lift procedures were performed. Of these, 10 patients developed postoperative hematomas. Benzodiazepines were commonly administered preoperatively to reduce anxiety level. Intraoperatively, a specific regimen and combination of inhalation agents, neuromuscular blockers, antiemetics, antihypertensives, and narcotics was given to control the ease of induction and emergence from anesthesia. Postoperatively, nausea, vomiting, anxiety, pain, and hypertension were treated as needed.. The described protocol is safe and has been instituted at the authors' facility for approximately 20 years. The benefit of this regimen is related to the synergy of combination therapy. It is successful in reducing patient anxiety and pain, controlling blood pressure and postoperative emesis, and subsequently results in a reduced risk of hematoma.. Therapeutic, IV.

Topics: Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Androstanols; Anesthesia; Anesthetics, Inhalation; Anesthetics, Intravenous; Anxiety; Female; Follow-Up Studies; Humans; Incidence; Intraoperative Complications; Male; Methyl Ethers; Midazolam; Middle Aged; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Pain, Postoperative; Patient Satisfaction; Retrospective Studies; Rhytidoplasty; Rocuronium; Sevoflurane; Sufentanil; Texas

We report the anesthetic management of a female neonate with congenital cyst adenoid malformation (CCAM) type III of the lung who underwent the lower right lobe resection 22 days after birth. General anesthesia was induced with propofol and rocuronium. The trachea was intubated with a 3.0 standard tube. Anesthesia was maintained with sevoflurane in an air/oxygen mixture and fentanyl. Intraoperative anesthetic course was uneventful except transient desaturation during lung compression. Immediately, the saturation was restored by interruption of lung compression. One lung ventilation was not necessary in this operation. Postoperative course was uneventful. Patient was discharged home on the 28th postoperative day.

Topics: Androstanols; Anesthesia, General; Cystic Adenomatoid Malformation of Lung, Congenital; Female; Humans; Infant, Newborn; Intubation, Intratracheal; Pain, Postoperative; Perioperative Care; Pneumonectomy; Propofol; Respiratory Insufficiency; Rocuronium

Topics: Abdominal Cavity; Androstanols; Anesthesia, Inhalation; Anesthetics, Inhalation; Female; Humans; Infant; Intestinal Obstruction; Isoflurane; Laparotomy; Methyl Ethers; Nerve Block; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Rocuronium; Sevoflurane

Patients with Myotonic Dystrophy show an unpredictable response to several anesthetic drugs including opioids, neuromuscular blocking agents and especially reversal agents like neostigmine. We describe the case of a 40 year old patient with myotonic dystrophy who underwent laparoscopic cholecystectomy and ovarian cyst removal under general anesthesia. The authors suggest the use of the new reversal agent suggamadex, for reversing neuromuscular blockade caused by rocuronium, in patients suffering from neuromuscular disease and especially from Myotonic Dystrophy, because it rapidly and completely reverses any residual neuromuscular blockade, but also underline the increased susceptibility of these patients to opioids.

Topics: Adult; Analgesics, Opioid; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Cholecystectomy, Laparoscopic; Female; gamma-Cyclodextrins; Humans; Meperidine; Myotonic Dystrophy; Naloxone; Narcotic Antagonists; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Ovarian Cysts; Pain, Postoperative; Respiratory Insufficiency; Rocuronium; Sugammadex

Topics: Aged; Amides; Analgesia, Epidural; Analgesics, Non-Narcotic; Androstanols; Anesthesia, General; Anesthetics, Dissociative; Contraindications; Drug Hypersensitivity; Fentanyl; Humans; Ketamine; Male; Methyl Ethers; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Preanesthetic Medication; Propofol; Rocuronium; Ropivacaine; Sevoflurane; Skin Tests; Spinal Fusion; Succinylcholine

Thymectomy continues to be the treatment of choice for certain patients with myasthenia gravis. As surgical techniques have developed, anesthesiologists have considered the need to adapt anesthetic techniques to improve care of patients undergoing this procedure. We describe the anesthetic management of 2 patients undergoing thymectomy performed with a bilateral thoracoscopic approach. Because it is best to avoid the use of opiates during and after surgery, we performed a bilateral paravertebral thoracic block, inserting the catheters into the paravertebral space on each side to infuse local anesthetics on either side as needed as the operation progressed. Surgery was completed without adverse events and tubes were removed from the tracheas of both patients at the end of the procedures. Bilateral continuous infusion of local anesthetics provided satisfactory analgesia on the following days.

Topics: Adult; Analgesia; Androstanols; Anesthesia, Inhalation; Anesthetics, Local; Combined Modality Therapy; Contraindications; Dose-Response Relationship, Drug; Female; Humans; Methyl Ethers; Myasthenia Gravis; Nerve Block; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pyridostigmine Bromide; Rocuronium; Sevoflurane; Thoracic Surgery, Video-Assisted; Thymectomy; Thymoma; Thymus Neoplasms

Topics: Accidents; Androstanols; Epidural Space; Humans; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Rocuronium; Wakefulness