A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg
elderly patients
neuromuscular blocking agents
tracheal intubating conditions
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
revised:
07
06
2021
received:
21
04
2021
accepted:
10
07
2021
pubmed:
27
7
2021
medline:
9
11
2021
entrez:
26
7
2021
Statut:
ppublish
Résumé
To facilitate tracheal intubation, either a neuromuscular blocking agent or a bolus dose of remifentanil can be administered. We hypothesized that rocuronium 0.6 mg·kg A total of 78 patients were randomized to either rocuronium 0.6 mg·kg No difference in the occurrence of excellent intubating conditions was found comparing the rocuronium group with the remifentanil group; 10 (28%) versus 15 (39%) (p = .29), respectively, relative risk = 0.72. Interventions against hypotension were used in 24 (67%) versus 28 (74%) (p = .51), respectively. Hoarseness and sore throat 24 h postoperatively were found in 37% versus 35% p = .86, and 14% versus 5% p = .20, respectively. The IDS score was 2 versus 2 p = .48. No difference in intubating conditions was found 2 min after the administration of either rocuronium 0.6 mg·kg NCT04287426.
Sections du résumé
BACKGROUND
BACKGROUND
To facilitate tracheal intubation, either a neuromuscular blocking agent or a bolus dose of remifentanil can be administered. We hypothesized that rocuronium 0.6 mg·kg
METHODS
METHODS
A total of 78 patients were randomized to either rocuronium 0.6 mg·kg
RESULTS
RESULTS
No difference in the occurrence of excellent intubating conditions was found comparing the rocuronium group with the remifentanil group; 10 (28%) versus 15 (39%) (p = .29), respectively, relative risk = 0.72. Interventions against hypotension were used in 24 (67%) versus 28 (74%) (p = .51), respectively. Hoarseness and sore throat 24 h postoperatively were found in 37% versus 35% p = .86, and 14% versus 5% p = .20, respectively. The IDS score was 2 versus 2 p = .48.
CONCLUSION
CONCLUSIONS
No difference in intubating conditions was found 2 min after the administration of either rocuronium 0.6 mg·kg
CLINICAL TRIALS REGISTRATION
BACKGROUND
NCT04287426.
Substances chimiques
Androstanols
0
Anesthetics, Intravenous
0
Neuromuscular Nondepolarizing Agents
0
Piperidines
0
Remifentanil
P10582JYYK
Rocuronium
WRE554RFEZ
Propofol
YI7VU623SF
Banques de données
ClinicalTrials.gov
['NCT04287426']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1367-1373Informations de copyright
© 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Références
Bouvet L, Stoian A, Rimmelé T, Allaouchiche B, Chassard D, Boselli E. Optimal remifentanil dosage for providing excellent intubating conditions when co-administered with a single standard dose of propofol. Anaesthesia. 2009;64:719-726.
Lundstrøm LH, Duez CHV, Nørskov AK, et al. Effects of avoidance or use of neuromuscular blocking agents on outcomes in tracheal intubation: a cochrane systematic review. Br J Anaesth. 2018;120:1381-1393.
Manku K, Bacchetti P, Leung JM. Prognostic significance of postoperative in-hospital complications in elderly patients. I. Long-term survival. Anesth Analg. 2003;96:583-589.
Sieber FE, Barnett SR. Preventing postoperative complications in the elderly. Anesthesiol Clin. 2011;29:83-97.
Bjerring C, Vested M, Arleth T, Eriksen K, Albrechtsen C, Rasmussen LS. Onset time and duration of action of rocuronium 0.6 mg/kg in patients above 80 years of age: a comparison with young adults. Acta Anaesthesiol Scand. 2020;64:1082-1088.
Varrique RM, Lauretti GR, Matsumoto JA, Lanchote VL, de Moraes NV. Pharmacokinetics and pharmacodynamics of rocuronium in young adult and elderly patients undergoing elective surgery. J Pharm Pharmacol. 2016;68:1351-1358.
Adamus M, Hrabalek L, Wanek T, Gabrhelik T, Zapletalova J. Influence of age and gender on the pharmacodynamic parameters of rocuronium during total intravenous anesthesia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011;155:347-353.
Murphy GS, Szokol JW, Avram MJ, et al. Residual neuromuscular block in the elderly: incidence and clinical Implications. Anesthesiology. 2015;123:1322-1336.
Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg. 2010;111:120-128.
Kirmeier E, Eriksson LI, Lewald H, et al. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study. Lancet Respir Med. 2019;7:129-140.
Stevens JB, Wheatley LD. Tracheal intubation in ambulatory surgery patients: Using remifentanil and propofol without muscle relaxants. Anesth Analg. 1998;86:45-49.
Schlaich N, Mertzlufft F, Soltész S, Fuchs-Buder T. Remifentanil and propofol without muscle relaxants or with different doses of rocuronium for tracheal intubation in outpatient anaesthesia. Acta Anaesthesiol Scand. 2000;44:720-726.
Alexander R, Olufolabi AJ, Booth J, El-Moalem HE, Glass PS. Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants. Anaesthesia. 1999;54:1037-1040.
Boztas N, Oztekin S, Ozkardes S, Akan M, Ozbilgin S, Baytok A. Effects of different doses of remifentanil on hemodynamic response to anesthesia induction in healthy elderly patients. Curr Med Res Opin. 2017;33:85-90.
Goo EK, Oh AY, Cho SJ, Seo KS, Jeon YT. Optimal remifentanil dosage for intubation without muscle relaxants in elderly patients. Drugs Aging. 2012;29:905-909.
Dixon JR. The international conference on harmonization good clinical practice guideline. Qual Assur. 1999;6(2):65-74
Fuchs-Buder T, Claudius C, Skovgaard LT, Eriksson LI, Mirakhur RK, Viby-Mogensen J. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007;51:789-808.
Adnet F, Borron SW, Racine SX, et al. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology. 1997;87:1290-1297.
Mencke T, Jacobs RM, Machmueller S, et al. Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial. BMC Anesthesiol. 2014;14:39.
Bouvet L, Stoian A, Jacquot-Laperrière S, Allaouchiche B, Chassard D, Boselli E. Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study. Can J Anesth. 2008;55:674-684.
Hanna SF, Ahmad F, Pappas ALS, et al. The effect of propofol/remifentanil rapid-induction technique without muscle relaxants on intraocular pressure. J Clin Anesth. 2010;22:437-442.
Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41:67-76.
Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865-877.
Kleine-Brueggeney M, Buttenberg M, Greif R, Nabecker S, Theiler L. Evaluation of three unchannelled videolaryngoscopes and the Macintosh laryngoscope in patients with a simulated difficult airway: a randomised, controlled trial. Anaesthesia. 2017;72:370-378.
Shiraishi N, Aono M, Kameyama Y, Yamamoto M, Kitajima O, Suzuki T. Effects of cardiac output on the onset of rocuronium-induced neuromuscular block in elderly patients. J Anesth. 2018;32:547-550.
Szmuk P, Ezri T, Chelly JE, Katz J. The onset time of rocuronium is slowed by esmolol and accelerated by ephedrine. Anesth Analg. 2000;90:1217-1219.
Meistelman C, Plaud B, Donati F. Rocuronium (ORG 9426) neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis in humans. Can J Anaesth. 1992;39:665-669.