Rocuronium, Long Last Forever?

Authors

  • Inês Portela Serviço de Anestesiologia, Centro Hospitalar Universitário do Algarve, Algarve, Portugal
  • Miguel Jacob Serviço de Anestesiologia, Centro Hospitalar Universitário do Algarve, Algarve, Portugal
  • Catarina Monteiro Serviço de Anestesiologia, Centro Hospitalar Universitário do Algarve, Algarve, Portugal
  • Paula Silva Serviço de Anestesiologia, Centro Hospitalar Universitário do Algarve, Algarve, Portugal
  • Ana Lares Serviço de Anestesiologia, Centro Hospitalar Universitário do Algarve, Algarve, Portugal

DOI:

https://doi.org/10.25751/rspa.15968

Keywords:

Aged; Laparoscopy; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Rocuronium

Abstract

It is known there is a wide variability in duration of action of nondepolarizing muscle relaxants which contributes to the considerable incidence of residual neuromuscular blockade and its multiple deleterious consequences for the patient. We report a case of an elderly otherwise healthy male patient with an unusually
long-lasting neuromuscular blockade during laparoscopic surgery, illustrating the relevance of objective neuromuscular monitoring in an adequate and safe patient recovery and discussing factors that can potentiate rocuronium bromide duration of action.

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References

1. Esteves S, Roxo A, Resendes H, Pereira L, Fernandes N, Borges S, et al. Recomendações Portuguesas para a Gestão do Bloqueio Neuromuscular - 2017. Rev Soc Port Anestesiol. 2018;25:4-29.
2. Esteves S, Martins M, Barros F, Canas M, Vítor P, Seabra M, et al. Incidence of postoper-ative residual neuromuscular blockade in the post anesthesia care unit: an observational multicentre study in Portugal. Eur J Anesthesiol. 2013;30:243-9. doi: 10.1097/EJA.0b013e32835dccd7.
3. Rocuronium Bromide Injection [package insert]. Lake Zurich: Fresenius Kabi; 2015.
4. Soares M, Esteves S. Significantly prolonged neuromuscular blockade after a single dose of rocuronium. Eur J Anaesthesiol 2016; 33: 693-4. doi: 10.1097/EJA.0000000000000468.
5. Claudius C, Karacan H, Viby-Mogensen J. Prolonged residual paralysis after a single intu-bating dose of rocuronium. Br J Anaesth. 2007;99:514-7.
6. Arain SR, Kern S, Ficke DJ, Ebert TJ. Variability of duration of action of neuromuscular-blocking drugs in elderly patients. Acta Anaesthesiol Scand. 2005;49:312-5.
7. Naguib M, Lien C, Meistelman C. Pharmacology of Neuromuscular Blocking Drugs. In: Miller’s Anesthesia. 8th ed. Amsterdam: Elsevier; 2014. p. 958-94.
8. Xue FS, Liao X, Tong SY, Liu JH, An G, Luo LK. Dose-response and timecourse of the effect of rocuronium bromide during sevoflurane anaesthesia. Anaesthesia. 1998;53:25-30.
9. Driessen JJ, Crul JF, Vree TB, van Egmond J, Booij LH. Benzodiazepines and neuromus-cular blocking drugs in patients. Acta Anaesthesiol Scand. 1986;30:642-6.
10. Hepağuşlar H, Oztekin S, Mavioğlu O, Tuncali B, Elar Z. The effect of midazolam pre-medication on rocuronium-induced neuromuscular blockade. J Int Med Res. 2002 ;30:318-21.
11. Wang T, Huang S, Geng G. Comparison of the duration of neuromuscular blockade following a single bolus dose of rocuronium during laparoscopic gynaecological surgery vs conventional open surgery. Anaesthesia.
2014;69:854-9. doi: 10.1111/anae.12707.
12. Liu Y, Cao W, Liu Y, Wang Y Lang R, Yue Y, Wu A. Changes in duration of action of rocuronium following decrease in hepatic blood flow during pneumoperitoneum for laparoscopic gynaecological surgery. BMC
Anesthesiol. 2017; 17: 45. doi: 10.1186/s12871-017-0335-1.
13. Bruintjes MH, van Helden EV, Braat AE, Dahan A, Scheffer GJ, van Laarhoven CJ, Warlé MC. Deep neuromuscular block to optimize surgical space conditions during laparo-scopic surgery: a systematic review and meta-analysis. Br J Anaesth. 2017;118:834-42. doi: 10.1093/bja/aex116.
14. Eriksson LI, Lennmarken C, Jensen E, Viby-Mogensen J. Twitch tension and train-of-four ratio during prolonged neuromuscular monitoring at different peripheral temperatures. Acta Anaesthesiol Scand. 1991; 35: 247-52.
15. Padmaja D, Mantha S. Monitoring of neuromuscular junction. Indian J Anaesth. 2002; 46: 279-88.

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Published

2019-05-28

How to Cite

Portela, I., Jacob, M., Monteiro, C., Silva, P., & Lares, A. (2019). Rocuronium, Long Last Forever?. Journal of the Portuguese Society of Anesthesiology, 28(2), 130–132. https://doi.org/10.25751/rspa.15968

Issue

Vol. 28 No. 2 (2019): Revista da Sociedade Portuguesa de Anestesiologia

Section

Case Report

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