rocuronium and Respiration-Disorders

The aim of this study was to compare intubating conditions and adverse events after sevoflurane induction in infants, with or without the use of rocuronium or alfentanil.. Seventy-five infants, aged 1-24 months, undergoing elective surgery under general anaesthesia were randomly assigned to receive 8% sevoflurane with either placebo (i.v. saline 0.5 ml kg⁻¹), rocuronium (0.3 mg kg⁻¹), or alfentanil (20 µg kg⁻¹). The primary outcome measure was intubating conditions evaluated 90 s after test drug injection by an anaesthetist unaware of the patient's group. The secondary outcome criteria were respiratory (Sp(O₂) <90%, laryngospasm, closed vocal cords preventing intubation, bronchospasm) and haemodynamic adverse events (heart rate and mean arterial pressure variations ≥30% control value).. Intubating conditions were significantly better in the rocuronium group, with clinically acceptable intubating conditions in 92%, vs 70% in the alfentanil group and 63% in the placebo group (P=0.044). Adverse respiratory events were significantly less frequent in the rocuronium group: 0% vs 33% in the placebo group and 30% in the alfentanil group (P=0.006). Haemodynamic adverse events were more frequent in the alfentanil group: 48% vs 7% in the placebo group and 16% in the rocuronium group (P=0.0019).. In 1- to 24-month-old infants, the addition of 0.3 mg kg⁻¹ rocuronium to 8% sevoflurane improved intubating conditions and decreased the frequency of respiratory adverse events. Alfentanil provided no additional benefit in this study.

Topics: Alfentanil; Analgesics, Opioid; Androstanols; Anesthetics, Inhalation; Cardiovascular Diseases; Child, Preschool; Double-Blind Method; Humans; Infant; Intubation, Intratracheal; Methyl Ethers; Neuromuscular Nondepolarizing Agents; Prospective Studies; Respiration Disorders; Rocuronium; Sevoflurane

To evaluate respiratory function in the post-operative early period of patients undergoing bariatric surgery using the sleeve gastrectomy technique.. This prospective, observational study was conducted at Bülent Ecevit University Health Application and Research Centre, Zonguldak, Turkey from June to December 2014, and comprised patients with planned bariatric sleeve gastrectomy under general anaesthesia. Participants were visited 12-24 hours before the operation to record accompanying diseases and demographic data. Before the operations, respiratory function test, maximum expiratory pressure, maximum inspiratory pressure and arterial blood gas assessment tests were done and recorded as T0. After one hour of the operation, Aldrete scores >9 and the above-mentioned tests were repeated and recorded as T1. SPSS 18 and MedCalc 12.2.1.0 were used for statistical analysis.. Of the 76 participants, 60(78%) were women and 16(21%) were men. The overall median age was 39 years (inter-quartile range: 32-47 years). The mean and median values for forced expiratory volume in 1 second, forced vital capacity, maximum inspiratory pressure, maximum expiratory pressure and the ratio between partial pressure of oxygen in arterial blood and fraction of inspired oxygen at T0 were 101±17, 102±17, 66 (interquartile range: 59-74), 114 (interquartile range: 100-138) and 379±49, respectively, compared with 78±18, 76±18, 53 (interquartile range: 48-59), 85 (interquartile range: 73-95) and 331±49at T1 (p<0.001 each). Also, 38(50%) participants were given sugammadex and 38(50%) were given neostigmine. At the end of the test, sugammadex (odds ratio: 5.80; 95% confidence interval: 1.26-26.69; p=0.024) and pre-operative ratio between partial pressure of oxygen in arterial blood and fraction of inspired oxygen (odds ratio: 1.04, 95% confidence interval: 1.02-1.06; p<0.0001) were found to correlate significantly.. Impairment of respiratory function was found during the early post-operative period.

Topics: Adult; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Bariatric Surgery; Blood Gas Analysis; Cholinesterase Inhibitors; Female; Fentanyl; Forced Expiratory Volume; Gastrectomy; Humans; Intubation, Intratracheal; Logistic Models; Male; Maximal Respiratory Pressures; Middle Aged; Multivariate Analysis; Muscle Strength; Neostigmine; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Odds Ratio; Oximetry; Partial Pressure; Postoperative Complications; Propofol; Respiration Disorders; Respiratory Muscles; Rocuronium; Sevoflurane; Sugammadex; Vital Capacity

Topics: Adolescent; Androstanols; Antidotes; Child; Cholinesterase Inhibitors; Delayed Emergence from Anesthesia; Female; gamma-Cyclodextrins; Humans; Kidney Transplantation; Monitoring, Intraoperative; Neuromuscular Monitoring; Neuromuscular Nondepolarizing Agents; Respiration Disorders; Rocuronium; Sugammadex; Time Factors; Treatment Outcome

A 71-year-old woman was scheduled for arthroscopic knee surgery. Anesthesia was administered with sevoflurane, fentanyl, and rocuronium bromide. Total dose of fentanyl was 200 microg and total dose of rocuronium bromide was 40mg. After surgery sugammadex 150 mg was given before awakening of the patient and appearance of spontaneous breathing. Immediately after the administration of sugammadex airway pressure increased to 37 cmH20, and ventilation became difficult. After naloxone 0.1 mg injection, ventilation improved dramatically. The cause of difficult ventilation was surmised to be upper airway reflex or muscle rigidity caused by reaction to fentanyl. We thought the phenomenon was clearly manifested by rapid recovery from muscle relaxation by injection of sugammadex. Before injection of sugammadex, it is necessary to confirm the effects of anesthetics on the patient's condition.

Topics: Aged; Airway Resistance; Androstanols; Anesthesia Recovery Period; Anesthetics; Arthroscopy; Female; gamma-Cyclodextrins; Humans; Menisci, Tibial; Neuromuscular Nondepolarizing Agents; Postoperative Complications; Respiration Disorders; Rocuronium; Sugammadex