2.The Effect of Pretreatment with Thiopental on Reducing Pain Induced by Rocuronium Injection.
Jong Taek PARK ; Jae Chan CHOI ; Young Soo YOO ; Young Bok LEE ; Soon Yul KIM ; Hyun Kyo LIM
Yonsei Medical Journal 2005;46(6):765-768
We examined whether pretreatment with a small dose of thiopental was effective in reducing pain induced by the intravenous injection of rocuronium. Withdrawal movement was used to assess pain reduction. Ninety patients were randomly assigned to one of two groups: patients in the control group were pretreated with 2 mL saline, and those in the thiopental group were pretreated with 2 mL (50 mg) thiopental. Thiopental 5 mg/kg was injected intravenously. After a loss of consciousness, the upper arm was compressed with a rubber tourniquet, and the pretreatment drugs were administered. Thirty seconds later the tourniquet was removed and 0.6 mg/kg rocuronium was administered. Withdrawal movement was assessed using a four-grade scale: no movement, movement limited to the wrist, to the elbow or to the shoulder. The frequency of withdrawal movement in the group pretreated with thiopental was lower than in the control group (34 vs. 13, p 0.05). We concluded that pretreatment with 2 mL (50 mg) thiopental is effective in reducing pain caused by the intravenous injection of rocuronium.
Thiopental/*therapeutic use
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Pain Measurement
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Pain/chemically induced/*prevention & control
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Neuromuscular Nondepolarizing Agents/*adverse effects
;
Middle Aged
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Male
;
Injections, Intravenous
;
Humans
;
Female
;
*Anesthetics, Intravenous
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Androstanols/*adverse effects
;
Adult
3.Effects of residual paralysis after a single intubating dose of rocuronium on postoperative pulmonary function of patients undergoing laparoscopic gynecological surgeries.
Yu-he BAI ; Hong-zhi REN ; Ai-lun LUO ; Yu-guang HUANG ; Tie-hu YE ; Xiang-yang GUO
Acta Academiae Medicinae Sinicae 2010;32(1):102-107
OBJECTIVETo evaluate the residual paralysis after a single intubating dose of rocuronium and its effect of residual paralysis after a single dose of rocuronium on the postoperative pulmonary function of patients undergoing laparoscopic gynecological surgeries.
METHODSSixty American Society of Anesthesiologists (ASA) I - II patients undergoing laparoscopic gynecological surgeries were randomly divided into rocuronium (R) group (n = 30) and rocuronium + neostigmine (R + N) group (n = 30).All patients received midazolam (0.02 mg/kg), fentanyl (1 microg/kg), propofol(1.5-2 mg/kg), and rocuronium (0.6 mg/kg) to facilitate tracheal intubation and no more relaxant thereafter. Anesthesia was maintained with isoflurane and nitrous oxide in oxygen (N(2)O:O(2) = 1:1). At the end of the procedure, neuromuscular blockade was not reversed in R group, while antagonism was accomplished with neostigmine (0.04 mg/kg) and atropine (0.02 mg/kg) in R + N group. Immediately after tracheal extubation and on arrival in the PACU, the train-of-four (TOF) ratio at the adductor pollicis of all patients were measured using acceleromyography. Forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), and peak expiratory flow rate (PEFR) of all patients were measured using spirometry before surgery, after administration of midazolam and fentanyl, immediately after tracheal extubation, on arrival in the PACU, and after the TOF ratio recovered to 1.0. The TOF ratio and pulmonary function between two groups were compared.
RESULTSImmediately after tracheal extubation and on arrival in the PACU, the mean TOF ratio in R group was significantly lower than that in R + N group (P < 0.05). The mean time to achieve TOF ratio of 0.9 and 1.0 in R group was significantly longer than in R + N group (P < 0.05). Immediately after tracheal extubation and on arrival in the PACU, FVC, FEV(1), and PEFR were significantly lower in R group than in R + N group (P < 0.05). FVC, FEV(1), and PEFR after administration of midazolam and fentanyl and after TOF ratio recovered to 1.0 were significantly lower than the baseline values in all patients (P < 0.01).
CONCLUSIONSAfter a single intubating dose of rocuronium, residual paralysis exists in the majority of patients undergoing laparoscopic gynecological surgeries. The pulmonary function is impaired after the surgery, even after recovery of TOF ratio to 1.0.
Adolescent ; Adult ; Airway Extubation ; Androstanols ; administration & dosage ; adverse effects ; Female ; Gynecologic Surgical Procedures ; Humans ; Intubation, Intratracheal ; Laparoscopy ; Middle Aged ; Neuromuscular Nondepolarizing Agents ; administration & dosage ; adverse effects ; Paralysis ; chemically induced ; Postoperative Period ; Respiratory Function Tests ; Young Adult
4.Sequential method for determining the maximum dose of mivacurium continuously infused for intraoperative neuromonitoring in thyroid surgery.
Yongjie CHEN ; Lianjun HUANG ; Yang LI ; Li TONG ; Xiaochen WANG ; Keshi HU ; Zeguo FENG
Journal of Southern Medical University 2018;38(12):1472-1475
OBJECTIVE:
To determine the maximum dose of continuously infused mivacurium for intraoperative neuromonitoring and observe its adverse effects in thyroid surgery.
METHODS:
Twenty-eight patients undergoing thyroid surgery with intraoperative neuromonitoring received continuous infusion of mivacurium at the initial rate of 5.43 μg?kg?min, and the infusion rate for the next patient was adjusted based on the response of the previous patient according to the results of neurological monitoring. The depth of anesthesia was maintained with sevoflurane and remifentanil during the surgery. The LD50 and 95% of mivacurium were calculated using Brownlee's up-and-down sequential method.
RESULTS:
The LD50 of continuously infused mivacurium was 8.94 μg?kg?min (95% : 8.89- 8.99 μg?kg?min) during thyroid surgery, which did not affect neurological function monitoring. Transient chest skin redness occurred after induction in 9 patients (32.1%). None of the patients experienced intubation difficulties or showed intraoperative body motions during the surgery.
CONCLUSIONS
In patients undergoing thyroid surgery under anesthesia maintained by inhalation and intravenous infusion, the LD50 of mivacurium was 8.94 μg?kg?min (95% : 8.89-8.99 μg?kg?min) for continuous infusion, which does not cause serious adverse effects during the operation.
Anesthesia
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Anesthetics, Inhalation
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Anesthetics, Intravenous
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Humans
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Intraoperative Neurophysiological Monitoring
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methods
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Lethal Dose 50
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Mivacurium
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administration & dosage
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adverse effects
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Neuromuscular Nondepolarizing Agents
;
administration & dosage
;
adverse effects
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Remifentanil
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Sevoflurane
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Thyroid Gland
;
surgery
5.A Comparison of the Effect of Lidocaine or Sodium Bicarbonate Mixed with Rocuronium on Withdrawal Movement, Mean Arterial Pressure and Heart Rate during Rocuronium Injection.
Journal of Korean Academy of Nursing 2009;39(2):270-278
PURPOSE: This study was performed to find out the effects of lidocaine or 8.4% sodium bicarbonate mixed with rocuronium on mean arterial pressure, heart rate and withdrawal movement. METHODS: Data collection was performed from December 15, 2006 through May 31, 2007. Seventy-five patients with American Society Anesthesiologist (ASA) physical status I & II, under general anesthesia, were randomly assigned to 1 of 3 groups: R group (RG) received rocuronium 0.6 mg/kg; RL group (RLG), rocuronium 0.6 mg/kg mixed with 2 mL of 2% lidocaine; RS group (RSG), rocuronium 0.6 mg/kg with the same volume of 8.4% sodium bicarbonate. Mean arterial pressure, heart rate and withdrawal movement were observed from its injection until 5 min after endotracheal intubation. RESULTS: The incidence of withdrawal movement with its corresponding injections was 72%, 40% and 4% in RG, RLG and RSG, respectively (p<.001). Score of withdrawal movement was the lowest in RSG of all groups (p<.001). While mean arterial pressure (p=.011) in RSG decreased significantly, and heart rate (p=.003) in RG increased more with its injection than before induction of anesthesia. CONCLUSION: Administration of the equivalent volume of 8.4% sodium bicarbonate with rocuronium is more effective than that of lidocaine with rocuronium compared with rocuronium only, in preventing withdrawal movement and in stabilizing mean arterial pressure and heart rate.
Adult
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Androstanols/administration & dosage/*adverse effects
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Anesthetics, Local/administration & dosage/*therapeutic use
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Blood Pressure/*drug effects
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Female
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Heart Rate/*drug effects
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Humans
;
Injections, Intravenous
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Lidocaine/administration & dosage/*therapeutic use
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Male
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Middle Aged
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Neuromuscular Nondepolarizing Agents/administration & dosage/*adverse effects
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Pain/*prevention & control
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Sodium Bicarbonate/*administration & dosage
6.Antihistamine Pretreatment to Reduce Incidence of Withdrawal Movement After Rocuronium Injection.
Ho Jun LEE ; Sung Jin HAN ; Heezoo KIM ; Il Ok LEE ; Myoung Hoon KONG ; Nan Suk KIM ; Sang Ho LIM ; Mi Kyoung LEE
Journal of Korean Medical Science 2009;24(5):879-882
The purpose of this study was to determine the effectiveness of antihistamine therapy for withdrawal movements caused by rocuronium injection. One hundred seventy one ASA I-II adults undergoing elective surgery were randomly assigned to one of two groups. Patients in the control group (Group C) were premedicated with 2 mL normal saline, and those in the antihistamine group (Group A) were pre-medicated with 2 mL (45.5 mg) pheniramine maleate. After the administration of thiopental sodium 5 mg/kg, rocuronium 0.6 mg/kg was injected. Withdrawal movements were assessed using a four-grade scale. The administration of antihistamine reveals lower grade of withdrawal movement after rocuronium injection.
Adult
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Androstanols/*administration & dosage/adverse effects
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Anesthetics, Intravenous/administration & dosage
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Double-Blind Method
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Female
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Histamine H1 Antagonists/*pharmacology
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Humans
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Incidence
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Injections, Intravenous
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Male
;
Middle Aged
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Movement/drug effects/physiology
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Neuromuscular Nondepolarizing Agents/*administration & dosage/adverse effects
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Pain/chemically induced
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Pain Measurement
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Pheniramine/*pharmacology
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Thiopental/administration & dosage