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Influence of age and gender on the pharmacodynamic parameters of rocuronium during total intravenous anaesthesia – a prospective study


Authors: Adamus Milan 1;  Hrabálek Lumír 2;  Wanek Tomáš 2;  Gabrhelík Tomáš 1;  Zapletalová Jana 3,4
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice a Lékařská fakulta Univerzity Palackého v Olomouci 1;  Neurochirurgická klinika, Fakultní nemocnice a Lékařská fakulta Univerzity Palackého v Olomouci 2;  Ústav lékařské biofyziky, Lékařská fakulta Univerzity Palackého v Olomouci 3;  Institut molekulární a translační medicíny, Lékařská fakulta Univerzity Palackého v Olomouci 4
Published in: Anest. intenziv. Med., 23, 2012, č. 1, s. 21-27
Category: Anaesthesiology - Original Paper

Overview

Influence of age and gender on the pharmacodynamic parameters of rocuronium during total intravenous anaesthesia – a prospective study

Objective:
To compare the pharmacodynamics of 0.6 mg . kg-1 rocuronium in young and older patients of both genders during total intravenous anaesthesia.

Design:
Clinical, observational, non-blinded study.

Setting:
Department of Anaesthesiology, University Hospital.

Materials and methods:
Following local ethics committee approval and informed consent, patients scheduled for surgery under total intravenous anesthesia (propofol/sufentanil) were divided into 4 study groups: 37 males aged 20–40, 40 males aged 60–75 yrs, 43 females aged 20–40 and 38 females aged 60–75 yrs. Neuromuscular block following rocuronium (0.6 mg kg-1) was monitored as follows: train-of-four [TOF] stimulation of the ulnar nerve at 15-s intervals, EMG of the adductor pollicis muscle. The onset time (from application of rocuronium to maximum depression of T1), clinical duration (from application to 25% recovery of T1), and time to full spontaneous recovery (from application to TOF-ratio ≥ 0.9) were determined for each patient. The Kruskal-Wallis test was used to compare differences between the groups; P < 0.05 was considered statistically significant.

Results:
The onset time (median [interquartile range]) in the respective groups was 90 [80–110]BCD, 135 [116–165]AC, 75 [60–90]ABD, and 120 [90–146]AC seconds. The clinical duration was 30 [25–42]BCD, 58 [53–67]AD, 50 [40–65]AD, and 85 [70–90]ABC min. The interval to full spontaneous recovery was 59 [51–67]BCD, 102 [75–106]A, 76 [66–91]AD, and 128 [94–137]AC min. (AP<0.05 vs. young males, BP<0.05 vs. elderly males, CP<0.05 vs. young females, DP<0.05 vs. elderly females).

Conclusion:
Females and the elderly were more sensitive to rocuronium.

Keywords:
rocuronium – neuromuscular blockade – age – gender


Sources

1. Herold, I. Svalová relaxancia v anesteziologii a intenzivní péči. 1. vydání. Praha: Maxdorf, 2004, 268 s.

2.  Lee, C. L., Katz, R. L. Clinical implications of new neuromuscular concepts and agents: So long, neostigmine! So long, sux! J. Crit. Care, 2009, 24, p. 43–49.

3. Lee, C. L. Goodbye Suxamethonium! Anaesthesia, 2009, 64 (S1), p. 73–81.

4.  Mencke, T., Soltesz, S., Grundmann, U., Bauer, M., Schlaich, N., Larsen, R., Fuchs-Buder, T. Time course of neuromuscular blockade after rocuronium. A comparison between women and men. Anaesthesist, 2000, 49, p. 609–612.

5.  Adamus, M, Gabrhelik, T, Marek, O. Influence of gender on the course of neuromuscular block following a single bolus dose of cisatracurium or rocuronium. Eur. J. Anaesthesiol., 2008, 25, p. 589–595.

6.  Arain, S., Kern, S., Ficke, D., Ebert, T. Variability of duration of action of neuromuscular blocking drugs in elderly patients. Acta Anaesthesiol. Scand., 2005, 49, p. 312–315.

7.  Adamus, M. Vliv věku na farmakodynamické vlastnosti cisatrakuria, rokuronia a vekuronia u mužů během totální intravenózní anestezie – prospektivní studie. Anest. intenziv. Med., 2010, 21, p. 78–84.

8.  Booij, L. H. D. J., Drobnik, L. Variability in the effect of muscle relaxants. Factors involved in the pharmacodynamic profile of neuromuscular blocking agents. Part II. Anestezjologia i Ratownictwo, 2009, 3, p. 154–184.

9.  Murphy, G. S., Szokol, J. W., Marymont, J. H., Greenberg, S. B., Avram, M. J., Vender, J. S. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth. Analg., 2008, 107, p. 130–137.

10.  Fritscherova, S., Adamus, M., Dostalova, K., Koutna, J., Hrabalek, L., Zapletalova, J., Uvizl, R., Janout, V. Can difficult intubation be easily and rapidly predicted? Biomed. Pap. Med. Fac. Univ. Palacky Olomouc Czech Repub., 2011, 155, p. 165–172.

11.  Cazalaa, J. B., Levron, J. C., Servin, F. Anesthetic agents used in TCI. Bibliographical study of anesthetic agents used in the Orchestra® Base Primea and Injectomat® TIVA Agilia. 2nd ed. Le Grand Chemin, Brezins (France): Fresenius Vial, 2009.

12.  Fuchs-Buder, T., Claudius, C., Skovgaard, L. T., Eriksson, L. I., Mirakhur, R. K., 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.

13.  Donati, F. Onset of action of relaxants. Can. J. Anaesth., 1988, 35, p. S52– 58.

14.  Naguib, M., Kopman, A. F., Ensor, J. E. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. Br. J. Anaesth., 2007, 98, p. 302–316.

15.  Adamus, M., Bělohlávek, R., Vujčíková, M., Janásková, E. Vliv odlišných dávek rocuronia na jeho farmakodynamický profil: prospektivní studie. Anest. intenziv. Med., 2004, 15, p. 269–275.

16.  Debaene, B., Plaud, B., Dilly, M. P., Donati, F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology, 2003, 98, p. 1042–1048.

17.  Murphy, G. S., Brull, S. J. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth. Analg., 2010, 111, p. 120–128.

18. Viby-Mogensen, J., Claudius, C. Evidence-based management of neuromuscular block. Anesth. Analg., 2010, 111, p. 1–2.

19.  Donati, F. Neuromuscular monitoring: what evidence do we need to be convinced? Anesth. Analg., 2010, 111, p. 6–8.

20.  Eriksson, L. I., Sundman, E., Olsson, R., Nilsson, L., Witt, H., Ekbery, O., Kuylenstierna, R. Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans. Anesthesiology, 1997, 87, p. 1035–1043.

21.  Berg, H., Roed, J., Viby-Mogensen, J., Mortensen, C. R., Engbaek, J., Skovgaard, L. T., Kristel, J. J. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol. Scand., 1997, 41, p. 1095–1103.

22.  Sauer, M., Stahn, A., Soltesz, S., Noeldge-Schomburg, G., Mencke, T. The influence of residual neuromuscular block on the incidence of critical respiratory events. A randomised, prospective, placebo-controlled trial. Eur. J. Anaesthesiol., 2011, 28, p. 842–848.

23.  Pleym, H., Spigset, O., Kharasch, E. D., Dale, O. Gender differences in drug effects: implications for anesthesiologists. Acta Anaesthesiol. Scand., 2003, 47, p. 241–259.

24. Soldin, O. P., Mattison, D. R. Sex differences in pharmacokinetics and pharmacodynamics. Clin. Pharmacokinet., 2009, 48, p. 143–157.

25.  Naguib, M., Lien, A. C. Pharmacology of Muscle Relaxants and their Antagonists. In Miller, R.D. (editor). Miller’s Anesthesia. 7th ed. Philadelphia: Churchill-Livingstone, Elsevier. 2010, p. 897.

26.  Bevan, D. R., Fiset, P., Balendran, P., Law-Min, J. C., Ratcliffe, A., Donati, F. Pharmacodynamic behaviour of rocuronium in the elderly. Can. J. Anaesth., 1993, 40, p. 127–132.

27.  Sieber, F. E., Pauldine, R. Geriatric Anesthesia. In Miller, R. D. (editor). Miller’s Anesthesia. 7th ed. Philadelphia: Churchill-Livingstone, Elsevier. 2010, p. 2271.

28.  Naguib, M., Brull, S. J. Sugammadex: a novel selective relaxant binding agent. Expert Rev. Clin. Pharmacol., 2009, 2, p. 37–53.

29.  Kopman, A. F., Eikermann, M. Antagonism of non-depolarising neuromuscular block: current practice. Anaesthesia, 2009, 64 (S1), p. 22–30.

30.  Caldwell, J. E. Clinical limitations of acetylcholinesterase antagonists. J. Crit. Care, 2009, 24, p. 21–28.

31.  Kopman, A. F. Neostigmine versus sugammadex: which, when, and how much? Anesthesiology, 2010, 113, p. 1010–1011.

32.  Miller, R. D., Ward, T. A. Monitoring and pharmacologic reversal of a nondepolarizing neuromuscular blockade should be routine. Anesth. Analg., 2010, 111, p. 3–5.

33.  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, p. 233–240.

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Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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