Abstract
Purpose
The aim of this study was to elucidate the relationship between the onset of rocuronium-induced neuromuscular block and arterial pressure-based cardiac output (CO) in elderly patients.
Methods
Forty elderly patients aged 65–83 years were enrolled in this study. After induction of anesthesia, contractions of the adductor pollicis muscle to ulnar nerve train-of-four stimulation were acceleromyographically evaluated and 1 mg/kg rocuronium was administered following CO measurement. The correlation between onset of rocuronium action and CO was analyzed.
Results
The mean [SD] CO reduced after induction of anesthesia from 5.1 [1.8] L/min to 3.8 [1.1] L/min. The onset time of rocuronium-induced neuromuscular block was 110.3 [23.9] s (range 60–165). There was a statistically significant inverse correlation between the onset time of rocuronium and CO [onset time (s) = − 13.2·CO + 159.7, R2 = 0.376].
Conclusions
In the elderly, CO influences the onset of action of rocuronium.
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References
Harrison GA, Junius F. The effect of circulation time on the neuromuscular action of suxamethonium. Anaesth Intensive Care. 1972;1:33–40.
Ezri T, Szmuk P, Warters RD, Gebhard RE, Pivalizza EG, Katz J. Changes in onset time of rocuronium in patients pretreated with ephedrine and esmolol-the role of cardiac output. Acta Anaesthesiol Scand. 2003;47:1067–72.
Goat VA, Yeung ML, Blakeney C, Feldman SA. The effect of blood flow upon the activity of gallamine triethiodide. Br J Anaesth. 1976;48:69–73.
Suzuki T, Aono M, Isaka T, Miyake E, Fukano N, Saeki S, Ogawa S. Effect of landiolol hydrochloride on suxamethonium-induced neuromuscular block. J Anesth. 2009;23:188–91.
Komatsu R, Nagata O, Ozaki M, Sessler DI. Ephedrine fails to accelerate the onset of neuromuscular block by vecuronium. Anesth Analg. 2003;97:480–3.
Paton WD, Waud DR. The margin of safety of neuromuscular transmission. J Physiol. 1967;191:59–90.
Audibert G, Donati F. The onset of rocuronium, but not of vecuronium or mivacurium, is modified by tourniquet inflation. Anesth Analg. 1996;82:848–53.
Yamamoto S, Yamamoto Y, Kitajima O, Maeda T, Suzuki T. Reversal of neuromuscular block with sugammadex: a comparison of the corrugator supercilii and adductor pollicis muscles in a randomized dose-response study. Acta Anaesthesiol Scand. 2015;59:892–901.
Priebe HJ. The aged cardiovascular risk patients. Br J Anaesth. 2000;85:763–8.
Herweling A, Latorre F, Herwig A, Horstick G, Kempski O, Gervais HW. The hemodynamic effects of ephedrine on the onset time of rocuronium in pigs. Anesth Analg. 2004;99:1703–7.
Suzuki T, Kitajima O, Ueda K, Kondo Y, Kato J, Ogawa S. Reversibility of rocuronium-induced profound neuromuscular block with sugammadex in younger and older patients. Br J Anaesth. 2011;106:823–6.
Yoshida F, Suzuki T, Kashiwai A, Furuya T, Konishi J, Ogawa S. Correlation between cardiac output and reversibility of rocuronium-induced moderate neuromuscular block with sugammadex. Acta Anaesthesiol Scand. 2012;56:83–7.
Epemolu O, Bom A, Hope F, Mason R. Reversal of neuromuscular blockade and simultaneous increase in plasma rocuronium concentration after the intravenous infusion of the novel reversal agent Org 25969. Anesthesiology. 2003;99:632–7.
Delbono O. Neural control of aging skeletal muscle. Aging Cell. 2003;2:21–9.
Smith DO, Williams KD, Emmerling M. Changes in acetylcholine receptor distribution and binding properties at the neuromuscular junction during aging. Int J Dev Neurosci. 1990;8:629–42.
Smith DO. Acetylcholine storage, release and leakage at the neuromuscular junction of mature adult and aged rats. J Physiol. 1984;347:161–76.
Dinenno FA, Seals DR, DeSouza CA, Tanaka H. Age-related decreases in basal limb blood flow in humans: time course, determinants and habitual exercise effects. J Physiol. 2001;531:573–9.
Kopman A, Lawson D. Milliamperage requirements for supramaximal stimulation of the ulnar nerve with surface electrodes. Anesthesiology. 1984;61:83–5.
Suzuki T, Fukano N, Kitajima O, Saeki S, Ogawa S. Normalization of acceleromyographic train-of-four ratio by baseline value for detecting residual neuromuscular block. Br J Anaesth. 2006;96:44–7.
Compton FD, Zukunft B, Hoffmann C, Zidek W, Schaefer JH. Performance of a minimally invasive uncalibrated cardiac output monitoring system (FloTrac™/Vigileo™) in haemodynamically unstable patients. Br J Anaesth. 2008;100:451–6.
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Takahiro Suzuki has received speaker fees from MSD Inc., Japan.
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Shiraishi, N., Aono, M., Kameyama, Y. et al. Effects of cardiac output on the onset of rocuronium-induced neuromuscular block in elderly patients. J Anesth 32, 547–550 (2018). https://doi.org/10.1007/s00540-018-2510-z
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DOI: https://doi.org/10.1007/s00540-018-2510-z