lunes, 18 de julio de 2016

Más de relajantes neuromusculares en geriatría / More on neuromuscular blockade in geriatrics

Julio 14, 2016. No. 2386




Relación en la concentración efectiva en el sitio diana de rocuronio y el grado de recuperación de la relajación neuromuscular en ancianos
The relationship between the target effective site concentration of rocuronium and the degree of recovery from neuromuscular blockade in elderly patients.
Fan X1, Ma M1, Li Z1, Gong S1, Zhang W1, Wen Y1.
Int J Clin Exp Med. 2015 Sep 15;8(9):16369-73. eCollection 2015.
Abstract
OBJECTIVE: To study the relationship between the target effective site concentration (Ce) of rocuronium and the degree of recovery fromneuromuscular blockade in elderly patients. METHODS:50 elderly patients (ASA grade II) scheduled for selective surgical procedure under general anaesthesia were randomly divided into two groups, A and B, with 25 cases in each group. The Ce of rocuronium for intubation was 3 μg·ml(-1) in both groups, and the Ce during operation were 0.8 and 1.0 μg·ml(-1) in group A and B, respectively. When target controlled infusion of rocuronium was stopped, without the administration of reversal agents for neuromuscular blockade, the relationship between Ce and the first twitch height (T1) was studied by regression analysis.RESULTS:There was a significant linear relationship between Ce and T1, and there was no statistical difference in regression coefficient and interception between group A and B (P>0.05).CONCLUSION:The degree of recovery from neuromuscular blockade could be judged by the target effective site concentration of rocuronium at the time of reversal from neuromuscular blockade in the elderly patients.
KEYWORDS:Rocuronium; geriatrics; neuromuscular blockade; pharmacodynamics

Comparación entre los efectos de rocuronio, vecuronio y Cisatracurio utilizando tren de 4 y pruebas clínicas en ancianos
Comparison between the Effects of Rocuronium, Vecuronium, and Cisatracurium Using Train-of-Four and Clinical Tests in Elderly Patients.
Anesth Pain Med. 2013 Spring;2(4):142-8. doi: 10.5812/aapm.8406. Epub 2013 Mar 26.
Abstract
BACKGROUND:Postoperative residual blockade, longer duration of action for neuromuscular blockade, and slower recovery were relatively common in elderly patients.OBJECTIVES:We aimed to investigate the safety of train-of-four ratio and clinical tests in the assessment of patient recovery, and to determine the effects of the rocuronium, vecuronium, and cisatracurium on intubation, extubation and recovery times in elderly patients undergoing abdominal surgery.PATIENTS AND METHODS:After obtaining institutional approval and informed consent, 60 patients over 60 years old and undergoing elective abdominal operations were included in this double-blind, randomized clinical trial. Following a standard anesthesia induction, 0.6mg kg-1 rocuronium, 0.1mg kg-1 vecuronium, and 0.1mg kg-1 cisatracurium were administered to the patients in Group R, Group V, and Group C, respectively. Train-of-four (TOF) ratios were recorded at 10-minute intervals during and after the operation. Modified Aldrete Score (MAS) and clinical tests were recorded in the recovery room at 10-minute intervals. In addition, intubation and extubation times, duration of recovery room stay, and any complications were recorded.RESULTS:Intubation time was found to be shorter in Group R than that in Groups V and C (P ˂ 0.001). Times to positive visual disturbances and grip strength tests were shorter in Group C than that in Group V (P = 0.016 and P = 0.011, respectively). In Group R and group C, time to TOF ≥ 0.9 was significantly longer than all positive clinical test times except grip strength (P < 0.05).CONCLUSIONS:We hold the opinion that cisatracurium is safer in elderly patients compared to other drugs. We also concluded that the usage of TOF ratio together with clinical tests is suitable for assessment of neuromuscular recovery in these patients.
KEYWORDS:Aged; Cisatracurium; Neuromuscular Blockade; Rocuronium; Vecuronium Bromide

Comité Europeo de Enseñanza en Anestesiología
Curso de Actualización en Anestesiología
Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras
Agosto 5-7, 2016. Tijuana BC, México
Información Dr. Sergio Granados Tinajero granadosts@gmail.com 

16th World Congress of Anaesthesiologists

28 August - 2 September 2016 
Hong Kong Convention and Exhibition Centre
World Federation of Societies of Anaesthesiologists
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