SUGAMMADEX REVERSAL FOR INTRAOPERATIVE AND POSTOPERATIVE AWAKENING OF PATIENTS WITH REPEATED ADMINISTRATION OF ROCURONIUM IN SPINAL SURGERY
Objective: The aim of the study was a clinical analysis of sugammadex reversal of neuromuscular blockade induced by rocuronium during spinal corrective surgical procedures with intraoperative awakening test (“wake-up-test”), including the repeated administration of rocuronium after the reversal of the neuromuscular block. Methods. 48 patients aged 15-18 underwent posterior scoliosis correction with pedicle fixation. All of them received a planned intraoperative wake-up-test. Sugammadex was administered at a dose of 2 mg/kg, while TOFR was 1-2. We evaluated the reversal time and the patients’ starting to follow the instructions; afterwards rocuronium was re-administered at a dose of 0,6 mg/kg. Also assessed was the rate of awakening, re-falling asleep, repeated awakening and extubation, along with side effects. Results. Muscle response to TOF stimulation exceeded 90% in all the patients over 3 min after the first sugammadex injection at 2 mg/kg. The repeated administration of rocuronium after a complete reversal of NMB at a dose of 0,6 mg/kg (reduced two times as compared with the recommended 1,2 mg/kg) caused a complete re-NM block in all the patients over 2-5 min. After the surgery all of them were extubated in 1.2±0.08 min after the repeated sugammadex administration (TOF ≥ 90%). Conclusion: The use of sugammadex at a dose of 2 mg/kg (TOFR 1-2) in the protocol of intra- and postoperative awakening during spinal surgery is characterized by high clinical and economic efficiency, safety and the possibility of the repeated administration of rocuronium at a dose of 0.6 mg / kg.
About the authorsEzhevskaya Anna A.
Lebedeva M.N., Shevchenko V.P., Ageenko A.M. et al. Optimization of anesthetic protection during the extensive reconstructive surgery of severe scoliosis spinal deformities. Sibirskiy konsilium. 2008; (2): 46-8. (In Russian)
Novikov V.V., Novikova M.V., Tsvetovskiy S.B., Lebedeva M.N., Mikhaylovskiy M.V. et al. Prophylaxis of neurological complications in the surgical correction of rough spinal deformities. Khirurgiya pozvonochnika. 2011; (3): 66-76.
Lebedeva M.N., Shevchenko V.P., Bykova E.V. et al. The technique of intraoperative awakening of patients during the anesthetic management of the surgical treatment of scoliosis in children and adolescents. In: Ural materials. Region. Med.-tehn. Seminar “Respiratory Support Modern Ventilator.” Ekaterinburg; 2001: 81. (in Russian)
Blusse van Oud-Alblas H.J., Peters J.W., de Leeuw T.G. A comparison in adolescents of composite auditory evoked potential index and bispectral index during propofol-remifentanil anesthesia for scoliosis surgery with intraoperative wake-up test. Anesth. Analg. 2008; 107: 1683-8.
Fung N.Y., Hu Y., Irvin M.G. et al. Comparison between sevoflurane / remifentanil and propofol / remifentanil anaesthesia in providing conditions for somatosensory evoked potential monitoring during scoliosis corrective surgery. Anaesth. Intensive Care. 2008; 36: 779-85.
Pajewski T.N., Arlet V., Phillips L.H. Current approach on spinal cord monitoring: the point of view of the neurologist, the anesthesiologist and the spine surgeon. Eur. Spine J. 2007; 16 (2): S115-29.
Penney R. Use of dexmedetomidine and ketamine infusions during scoliosis repair surgery with somatosensory and motor-evoked potential monitoring: a case report. AANA J. 2010; 78: 446-50.
Lieberman A., Lyon R., Feiner J. et al. The effect of age on motor evoked potentials in children under propofol/isoflurane anesthesia. Anaesth. Analg. 2006; 103: 316-21.
Zhang C.H., Ma W.Q., Yang Y.L. et al. Median effective effect-site concentration of sufentanil for wake-up test in adolescents undergoing surgery: a randomized trial. BMC Anesthesiol. 2015; 8: 15-27.
Vauzelle C., Stagnara P., Jouvinroux P. Functional monitoring of spinal cord activity during spinal surgery. Clin. Orthop. Relat. Res. 1973; 93: 173-8.
Cammu G., De Kam P.J., De Graeve K., Van den Heuvel M., Suy K., Morias K. et al. Repeat dosing of rocuronium 1,2 mg kg-1 after reversal of neuromuscular block by sugammadex 4,0 mg kg-1 in anaesthetized healthy volunteers: a modelling-based pilot study. Br. J. Anaesth. 2010; 105 (4): 487-92. doi: 10.1093/bja/aeq167. Epub 2010 Jul 14.
Iwasaki H., Sasakawa T., Takahoko K., Takagi S., Nakatsuka H., Suzuki T. et al. A case series of re-establishment of neuromuscular block with rocuronium after sugammadex reversal. J. Anesth. 2016; Mar 7. [Epub ahead of print].
Gorobets E.S., Balandin V.V., Anisimov M.A., Gruzdev V.E., Bekyashev A.Kh. Myorelaxation tactic with sugammadex in surgery with neurophysiological monitoring. Anesteziol. i reanimatol. 2012; (4): 80-1. (In Russian)
Gorobets E.S., Anisimov M.A. Emergency sugammadex reversal during the failed ventilation. Vestnik intensivnoy terapii. 2012; (3): 71-7. (In Russian)
Merck & Co Inc. BRIDION: EPAR - Product Information Annex I: Summary of Product Characteristics. London: European Medicines Agency; 2013. Available from: http://www.ema.europa.eu/docs/en_GB/ document library/EPAR Product Information/human/000,885/WC500052310. pdf. Accessed June 13, 2013.
Schaller S.J., Fink H. Sugammadex as a reversal agent for neuromuscular block: an evidence-based review. Core Evidence. 2013; 8: 57-67.
Duvaldestin P., Kuizenga K., Saldien V. et al. A randomized, dose-response study of sugammadex given for the reversal of deep rocuronium- or vecuronium-induced neuromuscular blockade under sevoflurane anesthesia. Anesth. Analg. 2010; 110 (1): 74-82.
Otomo S., Iwasaki H., Takahoko K., Onodera Y., Sasakawa T., Kunisawa T. et al. Prediction of optimal reversal dose of sugammadex after rocuronium administration in adult surgical patients. Anesthesiol. Res. Pract. 2014; 2014: 848051. doi: 10.1155/2014/848051. Epub 2014 Feb 11.
Derkach E.V., Avksent’eva M.V., Rebrova O.Yu., Schifman E.M., Ignat’eva V.I., Nikolaenko E.M. Clinical and economic evaluation of the use of sugammadex (Braydan) for reversal of neuromuscular block during the surgical interventions. Meditsinskie tekhnologii. Otsenka i vybor. 2013; (3): 44-55. (in Russian)
Sørensen M.K., Bretlau C., Gätke M.R. et al. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. Br. J. Anaesth. 2012; 108 (4): 682-9.
Lazarev V.V., Minorskaya T.Yu. The use of sugammadex in infants (the literature review). Rossiyskiy vestnik detskoy khirurgii, anesteziologii i reanimatologii. 2014; 4 (1): 72-8. (in Russian)
- Refbacks are not listed
Контент доступен под лицензией Creative Commons Attribution 3.0 License.