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Rocuronium bromide is an acetylcholine N2 receptor antagonist, which can be used as an auxiliary drug for general anesthesia. It has been reported that rocuronium has two possible metabolic pathways: N-dealkylation and O-deacetylation, which are mainly taken up by liver and excreted by bile in the form of primary drugs. In this paper, the metabolites of rocuronium in human bile were detected by UHPLC-QE-orbitrap-MS, thirteen metabolites were detected, including eleven phase I metabolites and two phase II metabolites, eleven of which had not been previously reported. At the same time, HEK293 cells overexpressing transporter were used to explore the transmembrane transport mechanism of rocuronium, the results showed that rocuronium was the substrate of MATE1, OCT1, OATP1B1 and OATP1B3. The above research results enrich the metabolic pathway of rocuronium in vivo, and put forward the possible transport mechanism of liver uptake and bile excretion, which can better guide the accurate and safe clinical drug application. The collection of human bile samples in this study was approved by the ethics committee of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (Approval Number: 2019-775-130-01).
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Dermatomyositis is an idiopathic inflammatory myopathy characterized by skin changes and muscle weakness. Depending on the involvement of various muscles, dermatomyositis can cause aspiration pneumonia, ventilatory impairment, and heart failure. Several reports have documented normal or prolonged neuromuscular blockade following administration of different non-depolarizing neuromuscular blockers in patients with dermatomyositis. We observed delayed onset of blockade and prolonged recovery following administration of 0.6 mg/kg rocuronium in a patient with dermatomyositis. However, when the train-of-four ratio reached 0.3, the patient was administered pyridostigmine and glycopyrrolate, which led to normal response to reversal of rocuronium. The patient was extubated without respiratory complications. The outcomes of this case indicate that response to the usual dosage of muscle relaxants in patients with dermatomyositis might be different from that in patients without this condition. Anesthesiologists should pay attention to preoperative cardiorespiratory evaluation and intraoperative neuromuscular monitoring.
Subject(s)
Humans , Anesthesia, General , Dermatomyositis , Glycopyrrolate , Heart Failure , Muscle Weakness , Muscles , Myositis , Neuromuscular Blockade , Neuromuscular Blocking Agents , Neuromuscular Monitoring , Pneumonia, Aspiration , Pyridostigmine Bromide , SkinABSTRACT
Background: Endotracheal intubation is required for giving general anesthesia for which adequate muscle relaxation is necessary Suxamethonium is still used as a relaxant for endotracheal intubation Rocuronium, a nondepolarizing muscle relaxant was compared here for tracheal intubating conditions Aim of the study: To compare the intubating conditions achieved in patients undergoing elective surgeries under General Anaesthesia with Suxamethonium or Rocuronium in 60 secs and complications in both groups Materials and methods: This study was conducted in Institute of Anaesthesiology and Critical care at Madras medical college, Chennai during the period 2014 – 15100 patients of ASA I and II were divided randomly into 2 groups undergoing elective surgeries: Group I - Suxamethonium Group II - Rocuronium assessed for intubating conditions after administration of the corresponding drug Results: The intubating conditions were excellent in group I Suxamethonium as against Group II Rocuronium in 60 secs According to the cooper scoring system the scores of vocal cord movement in group I (Suxamethonium) was 268 (mean) ± 0471 and in group II (Rocuronium) was 234±0557, the scores of response to intubation in group I (Suxamethonium) was 298±0141 and in group II (Rocuronium) was 270±0463 with better intubating conditions in group I receiving Suxamethonium than Rocuronium The results were significant with a p-value of<005 whereas the scores of jaw Stalin R, Raja Manikandan S A prospective, randomized controlled study to compare the intubating conditions achieved with suxamethonium and rocuronium bromide IAIM, 2018; 5(12): 72-76 Page 73 relaxation in group I patients (Suxamethonium) was 270 (mean)±0463 and group II patients (Rocuronium) was 252±0544 with better jaw relaxation Conclusion: Rocuronium can be used as an alternative when suxamethonium is contraindicated for rapid intubation but not if the anticipated difficult airway is present Rocuronium can be chosen as an alternative to it even in rapid sequence intubation in emergency cases, provided the airway is properly assessed and no anticipated difficult intubation is present
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Background: Abdominal masses are often incidentally discovered by a parent while bathing the child, palpated unexpectedly on routine physical examination, or detected on abdominal imaging. Aim: The objective of the present study was to observe intra-abdominal tumors in children less than 12 year. Materials and methods: Total 17 intra-abdominal tumors of both sexes under 12 years of age was collected and analyzes to determine the various types of intra-abdominal tumors in relation to age and sex. Study was done for a period of 4 years. Results: 1 to 5 years are more common pediatric age group with tumors in abdomen with 52.7%. Age under 5 years age group with 70.6%. Males are most commonly observed with pediatric tumors with 58.8% of total subjects. Male: female ratio is 1.2:1. Neuroblastoma was the most common tumor constituting 41.18 % of all cases, followed by Wilms’ tumor (23.53%), hepatoblastoma (11.76%), teratoma and granulosa cell tumor (11.76%). Conclusion: Neuroblastoma was the most common tumor. Most of the tumors were noted in children less than 5 years of age.
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El aumento universal en la prevalencia de obesidad ha causado que los anestesiólogos se vean frecuentemente enfrentados a anestesiar pacientes obesos. Pese a esto aún existen dudas respecto a cómo dosificar las drogas en estos pacientes. La literatura recomienda dosificar el rocuronio en obesos en base al peso ideal (IBW, iniciales del inglés Ideal Body Weight) pero esta sugerencia está basada más bien en la prudencia que en la evidencia. Se decidió explorar con análisis de sobrevida (análisis tiempo-evento), la duración del rocuronio en obesos al ser dosificado por peso ideal (IBW) y por peso real (TBW, iniciales del inglés de peso corporal total). Al administrar el rocuronio en base al peso real (TBW) se observó una prolongación en su duración de acción con un acortamiento de su latencia en relación con la dosificación en base al peso ideal (IBW). Hubo una marcada prolongación de la duración de acción y el índice de recuperación tanto al dosificar por peso real como peso ideal. Debido a esta sensibilidad aumentada al rocuronio en pacientes obesos recomendamos dosificarlo en base al peso ideal, excepto si se necesita intubar rápidamente...
The universal increase in prevalence of obesity has caused that anesthesiologist are frequently encountered with anesthetizing obese patients. There stills exists doubt on how to dosage drugs to these patients. Literature recommends dosing rocuronium in the obese based on ideal weight (IBW), being this suggestion based more on prudence than on evidence. Randomized control trial was designed for obese patients scheduled for bariatric surgery to study the pharmacodynamics of rocuronium in this population. Patients were randomly assigned into two groups: rocuronium dosage 0.6 mgkg-1 for real weight (TBW) or rocuronium dosage of 0.6mgkg-1 for ideal weight (IBW). Ideal weight was calculated according to Lemmens formula. The reference group was the dosage based on IBW. Previous calibration, evaluating the first twitch of train-of-four (T1), we registered onset time, clinical duration, recovery index, level of muscle relaxation to which the first reinforcement was administered and clinical duration of rocuronium reinforcement. A total of 100 patients were part of the study: 54 in group TBW and 46 in group IBW. When administering rocuronium based on real weight (TBW) a prolongation in clinical duration was found: Medium (IQR*); 79.5 (67 - 105) minutes versus 44.5(33 - 63.5 minutes) in the IBW group (p < 0.001) with a decrease in latency in the TBW group 120 (90-150secs.) versus the IBW group 180 (120 - 270 secs.) (p < 0.001). There were no differences in the recovery index between both levels of dosing. There was a marked prolongation of both clinical duration and recovery index in both groups, as supported in some literature. Based on the evidence, we recommend to dose rocuronium in obese patients based on ideal weight, with the exception of cases were quick intubation is required...
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Humans , Male , Adult , Female , Middle Aged , Androstanols/administration & dosage , Body Weight , Neuromuscular Nondepolarizing Agents/administration & dosage , ObesityABSTRACT
Objective To evaluate the effect of pretreatment with butorphanol to prevent injection pain of rocuronium bromide.Methods One hundred and fifty ASA Ⅰ-Ⅱ grade patients,undergoing elective surgery were divided into 3 groups by random digits table with 50 cases each.Butorphanol group received butorphanol 2 mg,fentanyl group received fentanyl 100 μg,and control group received 0.9％sodium chloride when general anesthesia induced.Anesthesia was induced with propofol 2 mg/kg and the test drug was injected over 30 s,120 s after the test drug injection,1％ rocuronium bromide 0.6 mg/kg was injected.Nausea,vomiting,apnea and bucking were recorded after drugs injection.Results The rates of rocuronium bromide injection pain in fentanyl group[10％(5/50)]and butorphanol group[8％(4/50)]were significant lower than that in control group[82％(41/50)](P ＜ 0.01).None of the patients discovered nausea,vomiting,apnea and bucking in 3 groups.Conclusion Pretreatment with 2 mg butorphanol reduced the incidence of rocuronium bromide injection pain,furthermore,there is no untoward reaction such as nausea,vomiting,apnea and bucking.
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Objective: To establish a HPLC method to determinate the content of rocuronium bromide. Methods: NH2-bonding silica gel was used as the stationary phase. The mobile phase consisted of 0.04 mol/L tetramethyl ammonium hydroxide (pH adjusted to 7.4 by phosphoric acid) and acetonitrile (10:90). The column temperature was 35°C. The detection wavelength was 207 nm. Results: The relation between concentration and peak area was linear in the range of 0.1251-2.0065 mg/ml with r2 of 0.9999. The average recovery rate was 99.9% with RSD of 0.1%. Conclusion: This method is exclusive, sensitive and is reliable for the determination of rocuronium bromide.
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OBJECTIVE:To establish a mercury-free perchloric acid potentiometric titration method for the content determination of rocuronium bromide.METHODS:Mettler DG113-SC was used as the composite electrode.The potentiometric titration was performed with glacial acetic acid and acetic anhydride as solvents and perchloric acid(0.1 mol?L-1) as titration.The method was compared with that stated in European Pharmacopeia.RESULTS:The linear range of rocuronium bromide was 0.150 1～0.401 3 g(r=0.999 9) with an average recovery within 99.90%～99.98%.The detection limit was 1.71 mg.There was no difference between results detected by two methods.CONCLUSION:The method is simple,sensitive and accurate for the content determination of rocuronium bromide.
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BACKGROUND: For pediatric anesthesia we frequently use rocuronium bromide, which is often associated with a localized withdrawal of the arm or generalized movements, that may cause harm to the patient. Lidocaine is said to be one of the better agents and reduce the incidence of movement associated with rocuronium injection in adults. The purpose of this study was to compare the effects on movement associated with rocuronium injection according to the method of lidocaine administration in children. METHODS: Two hundreds and four pediatric patients undergoing general anesthesia were randomly assigned to one of six groups (each group n = 34). Fifty seconds after the injection of thiopental sodium 5 mg/kg, the SM group was given mixture of rocuronium bromide 0.6 mg/kg and normal saline 0.05 ml/kg (same amount of 2% lidocaine 1 mg/kg) for 5-10 seconds. The LM 1.0 and LM 2.0 groups were given a mixture of rocuronium bromide 0.6 mg/kg and 2% lidocaine 1 mg/kg or 2 mg/kg, respectively. The LS 1.0, LS 1.5 and the LS 2.0 groups were given 2% lidocaine 1.0 mg/kg, 1.5 mg/kg, and 2.0 mg/kg respectively, 50 seconds after the injection of thiopental sodium, and rocuronium was given 5 seconds after the administration of lidocaine. Withdrawal movements after the injection of rocuronium were investigated. RESULTS: All of the SM group showed withdrawal movement and the LM 2.0, LS 1.0, LS 1.5, and LS 2.0 groups showed less withdrawal movement than the SM group. And the LS 1.0, LS 1.5, and LS 2.0 groups showed less movement than the LM 1.0 group. LS 2.0 group showed less withdrawal movement than LM 2.0 group. CONCLUSIONS: The sequential administration of lidocaine and rocuronium produced a better result than the administration of a mixture in terms of reducing withdrawal movement on rocuronium injection.
Subject(s)
Adult , Child , Humans , Anesthesia , Anesthesia, General , Arm , Incidence , Lidocaine , Neuromuscular Blockade , ThiopentalABSTRACT
The neuromuscular and cardiovascular effects and endotracheal intubating conditions of bolus intravenous rocuronium 0.6mg/kg or 0.75mg/kg in 20 patients under balanced anesthesia,were studied, Intubating conditions were evaluated as excellent or good in all patients,except for one with poor intubating conditions following 0.6mg/kg. Onset times of both groups were 73.1 s and 67.1 s;neuromuscular blockade durations 24.9min and 32.0min; 25% recovery times 37.3min and 45.4min; 75% recovery times 46.4min and 58.7min;recovery index 9.1min and 13.3min,respectively. The cardiovascular effects after rocuronium in both groups were minimal.