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1.
Br J Anaesth ; 116(2): 233-40, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26787792

RESUMO

BACKGROUND: The aim of this dose-finding study was to evaluate the dose-response relationship of sugammadex and neostigmine to reverse a commonly observed level of incomplete recovery from rocuronium-induced neuromuscular block, that is, a train-of-four ratio (TOFR) ≥0.2. METHODS: Ninety-nine anaesthetized patients received rocuronium 0.6 mg kg(-1) i.v. for tracheal intubation and, if necessary, incremental doses of 0.1-0.2 mg kg(-1). Neuromuscular monitoring was performed by calibrated electromyography. Once the TOFR recovered to 0.2, patients were randomized to receive sugammadex (0.25, 0.5, 0.75, 1.0, or 1.25 mg kg(-1) i.v.), neostigmine (10, 25, 40, 55, or 70 µg kg(-1) i.v.), or saline (n=9 per group). Primary and secondary end points were the doses necessary to restore neuromuscular function to a TOFR≥0.9 with an upper limit of 5 and 10 min for 95% of patients, respectively. RESULTS: Neostigmine was not able to fulfil the end points. Based on the best-fitting model, the sugammadex dose estimation for recovery to a TOFR≥0.9 for 95% of patients within 5 and 10 min was 0.49 and 0.26 mg kg(-1), respectively. CONCLUSION: A residual neuromuscular block of a TOFR of 0.2 cannot be reversed reliably with neostigmine within 10 min. In the conditions studied, substantially lower doses of sugammadex than the approved dose of 2.0 mg kg(-1) may be sufficient to reverse residual rocuronium-induced neuromuscular block at a recovery of TOFR≥0.2. CLINICAL TRIAL REGISTRATION: NCT01006720.


Assuntos
Eletromiografia/estatística & dados numéricos , Neostigmina/farmacologia , Bloqueio Neuromuscular , Monitoração Neuromuscular/estatística & dados numéricos , Fármacos Neuromusculares não Despolarizantes/antagonistas & inibidores , gama-Ciclodextrinas/farmacologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Androstanóis/antagonistas & inibidores , Período de Recuperação da Anestesia , Inibidores da Colinesterase/farmacologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Rocurônio , Cloreto de Sódio/administração & dosagem , Sugammadex , Adulto Jovem
2.
Acta Anaesthesiol Scand ; 59(7): 902-11, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25962311

RESUMO

BACKGROUND: Similar to volatile anaesthetics, propofol may influence neuromuscular transmission. We hypothesised that the administration of propofol influenced the potency of rocuronium depending on the duration of the administration. METHODS: After consent, patients scheduled for elective surgery randomly received rocuronium either after induction of anaesthesia with propofol (2 min of propofol, n = 36) or after 30 min of propofol infusion (30 min of propofol, n = 36). Remifentanil was given in both groups. Neuromuscular monitoring was performed by calibrated electromyography. The dose-response relationship of rocuronium was determined with a single-bolus technique (0.07, 0.1, 0.15, 0.2, 0.3 and 0.45 mg/kg rocuronium). The primary endpoints were the ED50 and ED95 of rocuronium after 2 and 30 min propofol. Data are presented as means with (95% confidence interval). The trial is registered with the Eudra-CT: 2009-012815-16. RESULTS: A total of 72 patients were included. Time to maximal neuromuscular blockade was significantly shorter in patients after 30 min of propofol [3.3 min (2.9-3.7)] compared with patients anaesthetised with 2 min of propofol [4.6 min (4.0-5.2)]. After 30 min of propofol, the slope of the dose-response curve was significantly steeper (30 min of propofol: 4.34 [3.62-5.05]; 2 min of propofol: [3.34 (2.72-3.96)], resulting in lower ED95 values of rocuronium (30 min of propofol: 0.287 mg/kg [0.221-0.368]; 2 min of propofol [0.391 mg/kg (0.296-0.520)]. The ED50 were not different between groups. CONCLUSION: The potency of rocuronium was significantly enhanced after propofol infusion for 30 min. Estimates of potency those are usually determined during steady-state anaesthesia might underestimate rocuronium requirements for endotracheal intubation at the time of induction.


Assuntos
Androstanóis/farmacologia , Anestésicos Intravenosos/farmacologia , Bloqueio Neuromuscular/métodos , Fármacos Neuromusculares não Despolarizantes/farmacologia , Propofol/farmacologia , Adulto , Idoso , Relação Dose-Resposta a Droga , Método Duplo-Cego , Sinergismo Farmacológico , Eletromiografia/efeitos dos fármacos , Feminino , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Rocurônio , Fatores de Tempo , Adulto Jovem
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