rocuronium and Sleep-Apnea--Obstructive

Mask ventilation progressively improves after loss of consciousness during anesthesia induction possibly due to progression of muscle paralysis. This double-blinded randomized placebo-controlled study aimed to test a hypothesis that muscle paralysis improves mask ventilation during anesthesia induction.. Forty-four adults patients including moderate to severe obstructive sleep apnea undergoing scheduled surgeries under elective general anesthesia participated in this study. Randomly-determined test drug either rocuronium or saline was blinded to the patient and anesthesia provider. One-handed mask ventilation with an anesthesia ventilator providing a constant driving pressure and respiratory rate (15 breaths per minute) was performed during anesthesia induction, and changes of capnogram waveform and tidal volume were assessed for one minute. The needed breaths for achieving plateaued-capnogram (primary variable) within 15 consecutive breaths were compared between the test drugs.. Measurements were successful in 38 participants. Twenty-one and seventeen patients were allocated into saline and rocuronium respectively. The number of breaths achieving plateaued capnogram did not differ between the saline (95% C.I.: 6.2 to 12.8 breaths) and rocuronium groups (95% C.I.: 5.6 to 12.7 breaths) (p = 0.779). Mean tidal volume changes from breath 1 was significantly greater in rocuronium group than saline group (95% C.I.: 0.56 to 0.99 versus 3.51 to 4.53 ml kg-IBW. Use of rocuronium facilitates tidal volume improvement during one-handed mask ventilation even in patients with moderate to severe obstructive sleep apnea.. The clinical trial was registered at (05/12/2013, UMIN000012495): https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000014515.

Topics: Adult; Anesthesia, General; Humans; Masks; Paralysis; Rocuronium; Sleep Apnea, Obstructive

Obstructive sleep apnoea and residual neuromuscular blockade are, independently, known to be risk factors for respiratory complications after major surgery. Residual effects of neuromuscular blocking agents are known to reduce the hypoxic ventilatory response in healthy volunteers. Patients with obstructive sleep apnoea have impaired control of breathing, but it is not known to what extent neuromuscular blocking agents interfere with the regulation of breathing in such patients. In a physiological study in 10 unsedated men with untreated obstructive sleep apnoea, we wished to examine if partial neuromuscular blockade had an effect on hypoxic ventilatory response (isocapnic hypoxia to oxygen saturation of 80%) and hypercapnic ventilatory response (normoxic inspired carbon dioxide 5%). The hypoxic ventilatory response was reduced by 32% (p = 0.016) during residual neuromuscular block (rocuronium to train-of-four ratio 0.7), but the hypercapnic ventilatory response was unaffected. We conclude that neuromuscular blockade specifically depresses peripheral chemosensitivity, and not respiratory muscle function since the hypercapnic ventilatory response was unaffected.

Topics: Adolescent; Adult; Aged; Carbon Dioxide; Humans; Hypercapnia; Hypoxia; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Oxygen; Prospective Studies; Pulmonary Ventilation; Respiratory Muscles; Risk Factors; Rocuronium; Sleep Apnea, Obstructive; Young Adult

Topics: Anesthesia; Carotid Body; Humans; Male; Neuromuscular Blockade; Neuromuscular Blocking Agents; Rocuronium; Sleep Apnea, Obstructive

Topics: Adult; Anesthesia; Depressive Disorder, Major; Electroconvulsive Therapy; Humans; Intubation, Intratracheal; Male; Neuromuscular Nondepolarizing Agents; Obesity; Rocuronium; Sleep Apnea, Obstructive; Sugammadex; Treatment Outcome

Topics: Delayed Emergence from Anesthesia; Humans; Hypoxia; Male; Neuromuscular Blockade; Rocuronium; Sleep Apnea, Obstructive

Sugammadex can reverse rocuronium-induced muscular relaxation by encapsulation of steroidal muscle relaxants without muscarinergic side effects. Clinical studies show effective dose-dependent reversal of neuromuscular blockades after rocuronium and vecuronium. We report on a patient with deep neuromuscular block at the end of surgery following rapid sequence induction of anesthesia with high-dose rocuronium, who could rapidly be reversed without side effects after adequate i.v. sugammadex application.

Topics: Androstanols; Anesthesia; Cholecystectomy, Laparoscopic; Contraindications; gamma-Cyclodextrins; Gastroesophageal Reflux; Humans; Hypertension; Intubation, Intratracheal; Male; Middle Aged; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Preanesthetic Medication; Rocuronium; Sleep Apnea, Obstructive; Succinylcholine; Sugammadex