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Abstract
Many adverse reactions to therapeutic drugs appear to be allergic in nature, and are thought to be triggered by patient-specific Immunoglobulin E (IgE) antibodies that recognize the drug molecules and form complexes with them that activate mast cells. However, in recent years another mechanism has been proposed, in which some drugs closely associated with allergic-type events can bypass the antibody-mediated pathway and trigger mast cell degranulation directly by activating a mast cell-specific receptor called Mas-related G protein-coupled receptor X2 (MRGPRX2). This would result in symptoms similar to IgE-mediated events, but would not require immune priming. This review will cover the frequency, severity, and dose-responsiveness of allergic-type events for several drugs shown to have MRGPRX2 agonist activity. Surprisingly, the analysis shows that mild-to-moderate events are far more common than currently appreciated. A comparison with plasma drug levels suggests that MRGPRX2 mediates many of these mild-to-moderate events. For some of these drugs, then, MRGPRX2 activation may be considered a regular and predictable feature after administration of high doses.
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Affiliation(s)
- Benjamin D. McNeil
- Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Huang W, Huang J, Wang D, Hu Y, Wang J, Lin H. Effect of nalbuphine on rocuronium injection pain. WORLD JOURNAL OF PEDIATRIC SURGERY 2021; 4:e000249. [DOI: 10.1136/wjps-2020-000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/03/2022] Open
Abstract
ObjectiveRocuronium-associated intravenous injection pain occurs frequently in children during induction of anesthesia. The aim of this study was to systematically evaluate the benefits of nalbuphine in patients with rocuronium-associated injection pain.MethodsNinety children undergoing tonsillectomy and adenoidectomy in our hospital between October 2019 and September 2020 were randomly divided into the following groups, with 30 patients per group: control group (group C), lidocaine group (group L), and nalbuphine group (group N). Routine 0.1 mg/kg midazolam and 2 mg/kg propofol were injected intravenously. After sedation, children in group C, group L, and group N were administered an intravenous injection of saline, lidocaine (10 mg/mL), or nalbuphine hydrochloride (2 mg/mL), respectively, at a dosage of 0.1 mL/kg. Intravenous injection of rocuronium stock solution (0.6 mg/kg) was administered 2 minutes later. Pain was evaluated using Ambeshs 4-pointscale. The incidence of rocuronium injection pain was compared among the three groups, and postoperative adverse reactions, such as drowsiness, bradycardia, hypotension, and respiratory depression, were evaluated.ResultsThe incidence of injection pain among children in group N was significantly lower than that in group C and group L (p<0.05). The incidence of drowsiness in group N was significantly higher than that in the other groups (p<0.05). The incidences of hypotension, bradycardia, and respiratory depression were not significantly different among the three groups (p>0.05).ConclusionsIntravenous nalbuphine during induction of anesthesia effectively prevented rocuronium-associated injection pain in children. Drowsiness is a complication.
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Kang HW, Kim HJ, Kim WY, Min WK, Min TJ, Lee YS, Kim JH. Effects of cranial electrotherapy stimulation on preoperative anxiety and blood pressure during anesthetic induction in patients with essential hypertension. J Int Med Res 2020; 48:300060520939370. [PMID: 32865096 PMCID: PMC7469723 DOI: 10.1177/0300060520939370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Cranial electrotherapy stimulation (CES) is a non-invasive treatment that improves symptoms such as anxiety and pain. The purpose of this study was to analyze the effect of CES pretreatment on levels of preoperative anxiety, pain, and hemodynamic responses—especially changes in blood pressure—during anesthetic induction in patients with essential hypertension. Methods Eighty patients undergoing general anesthesia were randomly assigned to receive either no pretreatment (control group, n = 40) or CES pretreatment (CES group, n = 40). Anxiety scores, systolic and diastolic blood pressures, mean arterial pressure, and heart rate were measured in the general ward the evening before surgery, as well as in the preoperative holding area, operating room, and after intubation. Withdrawal responses to rocuronium injection were also measured. Results Anxiety scores in the operating room were significantly lower in the CES group. Withdrawal responses to rocuronium injection were also significantly lower in the CES group. There were no significant differences in hemodynamic values between the two groups. Conclusions CES pretreatment reduces both preoperative anxiety levels and withdrawal responses to rocuronium injection. However, it does not have a significant effect on hemodynamic responses.
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Affiliation(s)
- Hee Won Kang
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Hyun Joong Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Woon Young Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Won Kee Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Too Jae Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Yoon Sook Lee
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jae Hwan Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
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Wang J, Cui Y, Liu B, Chen J. The efficacy of Antipyretic Analgesics administration intravenously for Preventing Rocuronium-Associated Pain/Withdrawal Response: a systematic review and meta-analysis. BMC Anesthesiol 2020; 20:89. [PMID: 32312228 PMCID: PMC7171835 DOI: 10.1186/s12871-020-00990-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 03/26/2020] [Indexed: 02/08/2023] Open
Abstract
Background Rocuronium-associated injection pain/withdrawal response (RAIPWR) was non-ideal but occurred frequently when injection intravenously during anesthesia induction. Many studies had reported that pretreating with antipyretic analgesics (AAs) could reduce the occurrence of RAIPWR, but there was no consensus yet. Therefore, this meta-analysis was designed to systematically evaluate the benefits of AAs on RAIPWR in patients. Methods PubMed, Cochrane Library, Ovid, EMbase, Chinese National Knowledge Infrastructure (CNKI), Wan Fang Data were searched by January 1st 2019 for randomized controlled trials (RCTs) applying AAs to alleviate RAIPWR in patients who underwent elective surgery under general anesthesia. Two investigators assessed quality of RCTs and extracted data respectively and the meta-analysis was carried on Revman 5.3 software. Moreover, we compared AAs in pros and cons directly with lidocaine, the most reported medicine to prevent RAIPWR. Results Data were analyzed from 9 RCTs totaling 819 patients. The results of Meta-analysis showed that compared to the control group, pretreating with AAs could prevent the total occurrence of RAIPWR [Risk ratio (RR), 0.52; 95% confidence interval (CI), 0.42 to 0.66; P < 0.0001], and took effect on moderate (RR, 0.56; 95%CI, 0.43 to 0.73; P < 0.0001) and severe RAIPWR (RR = 0.14; 95%CI, 0.08 to 0.24; P < 0.00001). When compared to lidocaine, the preventive effect was not so excellent as the latter but injection pain induced by prophylactic occurred less. Conclusion The currently available evidence suggested that pretreating with AAs intravenously could alleviate RAIPWR. Trial registration PROSPERO CRD42019129776.
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Affiliation(s)
- Jia Wang
- West China Hospital of Sichuan University, No. 37th, Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, P.R. China
| | - Yu Cui
- Chengdu Women's & Children's Central Hospital, Chengdu, 610000, P.R. China
| | - Bin Liu
- West China Hospital of Sichuan University, No. 37th, Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, P.R. China.
| | - Jianfeng Chen
- West China Hospital of Sichuan University, No. 37th, Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, P.R. China
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Reduction of the rocuronium-induced withdrawal reflex by MR13A10A, a generic rocuronium with a novel solution: A randomized, controlled study. PLoS One 2019; 14:e0223947. [PMID: 31665172 PMCID: PMC6821093 DOI: 10.1371/journal.pone.0223947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background Rocuronium induces venous pain and the withdrawal reflex during injection. MR13A10A, generic rocuronium with a novel solution, reduced the injection-induced withdrawal reflex in rodents. We hypothesized that MR13A10A would reduce the frequency and severity of injection-induced withdrawal reflexes compared with original rocuronium during clinical anesthesia induction. Methods This prospective, open (but assessor-blinded), randomized, controlled study was conducted at a single academic hospital. The assessor was blinded to the study condition in order to minimize observer bias. Participants were allocated to either MR13A10A or traditional formula groups by a blocked stratified randomization method. Participants in the MR13A10A group received MR13A10A, whereas the original rocuronium group received the same amount of original rocuronium. The primary outcome was presence of the withdrawal reflex after rocuronium injection. Severity of the withdrawal reflex, changes in blood pressure and heart rate, and the train of four (TOF) ratio were measured as secondary outcomes. The withdrawal reflex was assessed using a video recording in a blinded manner. Results Of the 149 participants, 76 were allocated to the MR13A10A group and 73 to the original rocuronium group. The frequency of the withdrawal reflex was significantly lower with MR13A10A compared with original rocuronium (19.7% and 54.8% for MR13A10A and original rocuronium groups, respectively, p<0.001). The odds ratio adjusted for cannulation site, cannula size, induction agent and age was 6.27 (95% CI, 2.87, 13.73 p<0.001). Original rocuronium was an independent factor related to a higher post-treatment heart rate. The proportions of TOF ratios = 0 were similar between the two groups. Conclusion The frequency and severity of the withdrawal reflex after injection were significantly reduced by using MR13A10A. MR13A10A might contribute to safe and less invasive anesthesia management.
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The analgesic efficacy and duration of lidocaine on vascular pain induced by hypertonic saline infusion: a double-blinded, randomized control trial. J Anesth 2019; 33:311-316. [PMID: 30838446 DOI: 10.1007/s00540-019-02628-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/26/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine the analgesic efficacy and analgesic duration of lidocaine 20 mg and 40 mg on eliminating the vascular pain associated with hypertonic saline infusion. METHOD Patients who complained pain during infusion of hypertonic saline were randomized into three groups. They received normal saline (Group C), or lidocaine 20 mg (Group L20), or lidocaine 40 mg (Group L40). An electronic stopwatch was used to record the time to onset (T1) and the time to termination (T2) of the analgesic effect, and the analgesic duration (AD) was calculated as T2 - T1. RESULTS The incidence of pain elimination was significantly higher in both of the lidocaine groups (83.3 and 56.1% in Groups L40 and L20, respectively) than in the saline group (16.3%). Furthermore, lidocaine 40 mg was significantly more effective than 20 mg in eliminating the pain. The analgesic duration was significantly longer in Group L40 than in Group L20 (211.4 ± 50.2 vs. 130.3 ± 39.5 s, P < 0.001) and Group C (211.4 ± 50.2 vs. 45.1 ± 14.5 s, P < 0.001), and the analgesic duration in Group L20 was significantly longer than in Group C (P < 0.001). The incidence of transient tinnitus/dizziness was significantly higher in Group L40 than in Group L20 (19.0 vs. 2.4%, P < 0.05). CONCLUSION A single bolus of Lidocaine was effective in eliminating the pain induced by hypertonic saline infusion, but just for a short period of time. Lidocaine (without venous occlusion) only provides a short analgesic duration for local vein.
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The Effect of 5-Hydroxytryptamine Receptor Antagonist in Preventing Pain/Limb Shrinkage Reaction Associated with Rocuronium Injection. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4128415. [PMID: 30079346 PMCID: PMC6069578 DOI: 10.1155/2018/4128415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/10/2018] [Accepted: 04/01/2018] [Indexed: 11/18/2022]
Abstract
Objectives To evaluate the effect and safety of 5-hydroxytryptamine (5-HT) receptor antagonist in alleviating the pain of patients under general anesthesia induced by rocuronium injection and preemptive analgesia. Methods Meta-analysis was conducted with RevMan 5.1 software by electronically retrieving the databases of PubMed, Embase, the Cochrane Library, WanFang Data, and CNKI and collecting the published random control tests (RCTs) where 5-hydroxytryptamine receptor antagonist was used to alleviate the pain/limb shrinkage reaction associated with rocuronium injection. Results Seven RTCs, including 556 patients, were included. The results of meta-analysis showed the following. (1) Compared to the control group, 5-HT receptor antagonist could prevent the total pain/limb shrinkage reaction associated with rocuronium injection [RR=0.62, 95% CI (0.54, 0.71), P<0.00001] and reduce the incidence rate of mild and moderate pain/limb shrinkage reaction associated with rocuronium injection [RR=0.46, 95% CI (0.33, 0.63), P<0.00001; RR=0.18, 95% CI (0.11, 0.31), P<0.000 01]. (2) Compared to the lidocaine group, the incidence rate was higher in preventing the pain/limb shrinkage reaction associated with rocuronium injection by 5-HT receptor antagonist, which was statistically significant [RR=1.33, 95% CI (1.05, 1.68), P=0.02]. Conclusion 5-hydroxytryptamine receptor antagonist may be effective in preventing the pain/limb shrinkage reaction associated with rocuronium injection.
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Yılmaz S, Hatiboğlu Y. The evaluation of the effect of venous diameter measurement by ultrasonography on pain and withdrawal response. J Anesth 2018; 32:375-380. [PMID: 29572726 DOI: 10.1007/s00540-018-2489-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/20/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Rocuronium and propofol are used in the induction of anesthesia give discomfort to the patients. We aimed to investigate the relationship between venous diameter measured using ultrasonography, and pain and withdrawal movements after propofol and rocuronium applied with intravenous (IV). METHODS This prospective-observational study was performed on 142 voluntary patients undergoing surgical operation under general anesthesia. An ultrasonography was used to measure the vein transverse diameter. Patients with a venous transverse diameter of ≤2 mm were classified as group 1 (n = 50), while patients with a diameter of > 2 mm were classified as group 2 (n = 92). The propofol pain was assessed according to the verbal rating scale (VRS). In addition, the withdrawal movements of the rocuronium injection were evaluated using the four-point scale. RESULTS There was no difference between the two groups in terms of the demographic data. The patients have pain after propofol 38.2% and withdrawal movements after rocuronium 42.4% were detected. The maximum number of patients without pain after propofol injection (78.2%) and without withdrawal movements after rocuronium (76%) was found to be higher in group 2 (p = 0.001). CONCLUSION In this study, we found a reduction in the incidence and severity of pain and withdrawal movements in intravenous propofol and rocuronium administration through peripheral venous vessels of large diameter. We believe that the clinical drug injection through vessels with large venous diameter with the help of USG may be a non-invasive, simple, and reliable method to reduce pain and withdrawal movements in propofol and rocuronium injections.
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Affiliation(s)
- Sinan Yılmaz
- Department of Anaesthesiology and Reanimation, Adnan Menderes University School of Medicine, Aydin, 09100, Turkey.
| | - Yasemin Hatiboğlu
- Department of Anaesthesiology and Reanimation, Adnan Menderes University School of Medicine, Aydin, 09100, Turkey
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Lim BG, Lee IO, Kim YS, Won YJ, Kim H, Kong MH. The utility of bispectral index monitoring for prevention of rocuronium-induced withdrawal movement in children: A randomized controlled trial. Medicine (Baltimore) 2017; 96:e5871. [PMID: 28079825 PMCID: PMC5266187 DOI: 10.1097/md.0000000000005871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study was designed to determine whether a deep hypnotic state with a bispectral index (BIS) value less than 40 could alleviate withdrawal movement (WM) upon rocuronium injection during anesthesia induction in children. METHODS Finally, 135 healthy children (3-12 years) scheduled for minor elective surgery were studied. Without premedication, anesthesia was induced with thiopental sodium 5 mg/kg. Patients were randomized into 2 groups (control vs experimental) and then by virtue of rocuronium injection time, patients in the experimental group were allocated into 2 groups, as follows: in the control group (group C; n = 45), rocuronium 0.6 mg/kg was administered at the loss of eyelash reflex; in the 1st experimental group, rocuronium 0.6 mg/kg was administered when BIS fell to less than 40 (group T; n = 45); however, if BIS did not fall below 40 after thiopental sodium administration, manual ventilation was provided with oxygen 6 L/minute using sevoflurane 8% and then rocuronium was administered when BIS fell below 40 (the 2nd experimental group, group S; n = 45). Rocuronium-induced WM was evaluated using a 4-point scale (no movement; movement/withdrawal involving the arm only; generalized response, with movement/withdrawal of more than 1 extremity, but no requirement for restraint of the body; and generalized response which required restraint of the body and caused coughing or breath-holding). RESULTS No significant differences were found among the groups for patient characteristics including age, sex, height, and location of venous cannula. However, body weight, height, and body mass index in group S were all smaller than those in group T. The incidence of WM caused by rocuronium was 100% in group C, 95.6% in group T, and 80% in group S, and was significantly lower in group S than in group C. The grade of WM was 3.7 ± 0.6 in group C, 3.2 ± 0.9 in group T, and 2.6 ± 1.0 in group S. It was significantly lower in group T than in group C and significantly lower in group S than in groups C and T. CONCLUSION The confirmation of a deep hypnotic state with BIS values lower than 40 using BIS monitoring can reduce the grade of rocuronium-induced WMs during anesthesia induction using thiopental sodium or sevoflurane in children.
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Rocuronium Bromide Inhibits Inflammation and Pain by Suppressing Nitric Oxide Production and Enhancing Prostaglandin E 2 Synthesis in Endothelial Cells. Int Neurourol J 2016; 20:296-303. [PMID: 28043117 PMCID: PMC5209582 DOI: 10.5213/inj.1632796.398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 12/12/2016] [Indexed: 01/21/2023] Open
Abstract
Purpose Rocuronium bromide is a nondepolarizing neuromuscular blocking drug and has been used as an adjunct for relaxation or paralysis of the skeletal muscles, facilitation of endotracheal intubation, and improving surgical conditions during general anesthesia. However, intravenous injection of rocuronium bromide induces injection pain or withdrawal movement. The exact mechanism of rocuronium bromide-induced injection pain or withdrawal movement is not yet understood. We investigated whether rocuronium bromide treatment is involved in the induction of inflammation and pain in vascular endothelial cells. Methods For this study, calf pulmonary artery endothelial (CPAE) cells were used, and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, Western blot, nitric oxide detection, and prostaglandin E2 immunoassay were conducted. Results Rocuronium bromide treatment inhibited endothelial nitric oxide synthase and suppressed nitric oxide production in CPAE cells. Rocuronium bromide activated cyclooxygenase-2, inducible nitric oxide synthase and increased prostaglandin E2 synthesis in CPAE cells. Conclusions Rocuronium bromide induced inflammation and pain in CPAE cells. Suppressing nitric oxide production and enhancing prostaglandin E2 synthesis might be associated with rocuronium bromide-induced injection pain or withdrawal movement.
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Polat R, Akın M, Keskin G, Ünal D, Dönmez A. Prevention of Withdrawal Movement Associated with the Injection of Rocuronium in Children: Comparison of Paracetamol and Lidocaine. Turk J Anaesthesiol Reanim 2016; 44:86-90. [PMID: 27366564 DOI: 10.5152/tjar.2016.20981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/11/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Pain from rocuronium injection is observed in 50%-80 % of patients. This study aimed to compare the effectiveness of pretreatment with paracetamol and lidocaine in preventing pain-induced withdrawal caused by the intravenous injection of rocuronium during the induction of general anaesthesia in paediatric patients. METHODS Ninety children were randomized into two groups using a simple drawing from the box method: a paracetamol group (Group P, n=45) and a lidocaine group (Group L, n=45). After anaesthesia induction, venous occlusion was applied by a paediatric cuff inflated to a pressure of 75 mmHg and by 50 mg paracetamol and 0.5 mg kg(-1) lidocaine was injected in Groups P and L, respectively. Venous occlusion was then released, followed by rocuronium injection (0.6 mg kg(-1)). Withdrawal was evaluated using a 4-point scale (1, no response; 2, movement at the wrist only; 3, movement/withdrawal involving arm only (elbow/shoulder) and 4, generalized response, movement/withdrawal in more than one extremity). RESULTS The incidence of withdrawal movement was 42% and 26% in the Groups P and L, respectively (p=0.120). Although no significant differences were noted in the number of patients who had no withdrawal movement and mild withdrawal movement in Groups P and L, compared with Group L, the incidences of moderate withdrawal movement were significantly higher in Group P (p<0.05). No patient in either group revealed generalized movement. CONCLUSION Using a venous occlusion technique, pretreatment with 50 mg paracetamol can prevent withdrawal movement caused by rocuronium injection in children but is not as effective as lidocaine to prevent moderate withdrawal movement.
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Affiliation(s)
- Reyhan Polat
- Clinic of Anaesthesiology and Reanimation, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mine Akın
- Clinic of Anaesthesia, Ankara Pediatrics Haematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Gülsen Keskin
- Clinic of Anaesthesia, Ankara Pediatrics Haematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Dilek Ünal
- Clinic of Anaesthesiology and Reanimation, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Aslı Dönmez
- Clinic of Anaesthesiology and Reanimation, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Na YC, Lee HG, Lee SH, Jang EA, Yoon MH. The efficacy of sevolflurane inhalation alone or its combination with intravenous remifentanil against withdrawal movements on rocuronium injection in children. Korean J Anesthesiol 2014; 67:373-7. [PMID: 25558336 PMCID: PMC4280473 DOI: 10.4097/kjae.2014.67.6.373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/02/2014] [Accepted: 07/08/2014] [Indexed: 11/30/2022] Open
Abstract
Background The aims of this study were to compare the efficacy of sevoflurane inhalation alone, intravenous remifentanil alone, and the combination of sevoflurane inhalation and remifentanil as pretreatment for the prevention of rocuronium-induced withdrawal movement in pediatric patients. Methods In this prospective, randomized study, 90 American Society of Anesthesiologists physical status I or II pediatric patients aged 3 to 10 years were randomly allocated to one of three treatment groups: The Group S comprising the patients receiving sevoflurane inhalation, the Group R comprising those doing intravenous remifentanil 0.5 µg/kg and the Group C comprising those doing sevoflurane inhalation+intravenous remifentanil 0.5 µg/kg. The response of the patients was graded based on a 4-point scale. Results The overall incidence of withdrawal movement on rocuronium injection was 54% (16/30) in the Group S, 57% (17/30) in the Group R and 17% (5/30) in the Group C. There was no significant difference in the incidence of withdrawal movements on rocuronium injection between the Group S and Group R. In addition, the incidence of withdrawal movements and generalized movement on rocuronium injection was significantly lower in the Group C as compared with the Group S and R (P < 0.05). Conclusions Our results indicate not only that there was no significant difference in the degree of the effect in lowering the incidence of withdrawal movements on rocuronium injection between sevoflurane inhalation and intravenous remifentanil but also that it was significantly higher when combined with intravenous remifentanil as compared with the single use of sevoflurane inhalation or intravenous remifentanil.
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Affiliation(s)
- Yun Chan Na
- Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School, Gwangju, Korea
| | - Hyung Gon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School, Gwangju, Korea
| | - Seong Heon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School, Gwangju, Korea
| | - Eun A Jang
- Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School, Gwangju, Korea
| | - Myung Ha Yoon
- Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School, Gwangju, Korea
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Lee KH, Rim SK, Lee JY, Lee SY, Lee SN, Lee EJ, Lee JH. Effects of pretreatment with intravenous palonosetron for propofol-remifentanil-based anesthesia in breast and thyroid cancer surgery: a double-blind, randomized, controlled study. Korean J Anesthesiol 2014; 67:13-9. [PMID: 25097733 PMCID: PMC4121488 DOI: 10.4097/kjae.2014.67.1.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/28/2013] [Accepted: 01/09/2014] [Indexed: 11/17/2022] Open
Abstract
Background We postulated that palonosetron, a novel antiemetic agent, might have the effect of alleviating injection pain from propofol and rocuronium. A double-blind, controlled study was undertaken to evaluate the effect of palonosetron on injection pain during total intravenous anesthesia and postoperative nausea and vomiting (PONV) using propofol-remifentanil in breast and thyroid cancer surgery. Methods Sixty patients were randomly allocated to one of two groups. Before injection of propofol and rocuronium, patients in group S (n = 30) received 4 ml of saline and patients in group P (n = 30) received 75 µg (1.5 ml) of palonosetron mixed with 2.5 ml of saline (n = 30). Patients were evaluated by a blinded anesthesiologist with regard to the scoring of injection pain of propofol, withdrawal response by rocuronium, PONV, shivering, postoperative pain, recall of pain, and overall satisfaction. Results The differences between groups in the incidence of injection pain due to propofol and rocuronium were insignificant. However, in group P, the severity of propofol-induced injection pain (3% vs. 33%, P = 0.003) and postoperative pain (P = 0.038) was significantly lower during the first 12 h after surgery. No differences were observed between the groups with respect to PONV, shivering, recall of pain, and overall satisfaction. Conclusions We concluded that pretreatment of palonosetron was effective to reduce the severity of propofol-induced injection pain and early postoperative pain, although it did not reduce the incidence of injection pain from propofol and rocuronium.
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Affiliation(s)
- Kye Hyeok Lee
- Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, Seoul, Korea
| | - Sung Kyu Rim
- Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, Seoul, Korea
| | - Ji Yeon Lee
- Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, Seoul, Korea
| | - So Young Lee
- Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, Seoul, Korea
| | - Su Nam Lee
- Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, Seoul, Korea
| | - Eun Ju Lee
- Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, Seoul, Korea
| | - Ji Heui Lee
- Department of Anesthesiology and Pain Medicine, Korean Cancer Center Hospital, Seoul, Korea
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Park HJ, Kang H, Kim EG, Choi J, Seo JS. EC50 and EC95 of remifentanil to prevent rocuronium-induced withdrawal movements in children. Korean J Anesthesiol 2014; 66:433-8. [PMID: 25006366 PMCID: PMC4085263 DOI: 10.4097/kjae.2014.66.6.433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 11/18/2013] [Accepted: 01/13/2014] [Indexed: 11/25/2022] Open
Abstract
Background Intravenous administration of rocuronium induces intense pain in most patients (60-100%). This could be harmful during anesthesia induction because of the unintended reflex movement of an unconscious patient in response to the pain. Previous studies have reported that remifentanil effectively reduces rocuronium-induced pain and withdrawal movements. This study was designed to evaluate the EC50 and EC95 of remifentanil to prevent withdrawal movements in children. Methods We enrolled a total of 171 pediatric patients scheduled for general anesthesia in this study. Remifentanil was administrated by target-controlled infusion. Effect-site target concentrations ranged from 0.5 to 3.0 ng/ml. At each concentration, experiments were repeated in 10-20 patients. Propofol 2 mg/kg and rocuronium 0.9 mg/kg were administrated after equilibration of plasma and effect-site target remifentanil concentration. The withdrawal movements were graded on a 4-point scale. The EC50 and EC95 of remifentanil to prevent rocuronium-induced withdrawal movements were determined by using a logistic regression model. Results The logistic regression model showed that the probability of preventing rocuronium-induced withdrawal movement was as follows: exp (-3.49 + 2.07 × remifentanil concentration) / (1 + exp [-3.49 + 2.07 × remifentanil concentration]). EC50 and EC95 were 1.69 ng/ml (95% confidence intervals [CIs], 1.42-1.87) and 3.11 ng/ml (95% CIs, 2.79-3.72), respectively. Conclusions Administration of remifentanil at an effect-site target concentration of 3.1 ng/ml could effectively prevent rocuronium-induced withdrawal movements.
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Affiliation(s)
- Hye Jin Park
- Department of Anesthesiology and Pain Medicine, Eulji Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Hyoseok Kang
- Department of Anesthesiology and Pain Medicine, Eulji Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Eu-Gene Kim
- Department of Anesthesiology and Pain Medicine, Eulji Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Juyoun Choi
- Department of Anesthesiology and Pain Medicine, Eulji Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Jeong Sung Seo
- Department of Anesthesiology and Pain Medicine, Eulji Hospital, Eulji University College of Medicine, Seoul, Korea
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15
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Kim E, Kim CH, Kim HK, Kwon JY, Lee DW, Kim HY. Effect of nitrous oxide inhalation on pain after propofol and rocuronium injection. J Anesth 2013; 27:868-73. [PMID: 23982855 DOI: 10.1007/s00540-013-1655-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 06/05/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE This prospective, double-blind, placebo-controlled study was designed to determine the efficacy of nitrous oxide (N(2)O) in alleviating the pain that followed sequential injection of propofol and rocuronium. METHODS A total of 205 adult patients (age, 18-68 years) received one of the following combinations: NaCl and 100 % O(2) (group C); 0.5 mg/kg lidocaine and 100 % O(2) (group L); NaCl and a mixture of 67 % N(2)O/O(2) (group N); or 0.5 mg/kg lidocaine and a mixture of 67 % N(2)O/O(2) (group LN). Vein occlusion was released after 1 min, and 5 ml propofol was injected over 10 s. Pain was evaluated on a visually enlarged, laminated, numeric rating (0-10) scale. The remainder of the induction dose of propofol (with a 3-ml bolus of normal saline and 0.6 mg/kg rocuronium) was then injected. The response to the rocuronium injection was assessed with a four-point scale (0-3). RESULTS The incidence and severity of pain from the propofol injection in groups L, N, and LN were significantly lower than those in group C (P < 0.001). Frequency and intensity of the withdrawal response were significantly less in groups N and LN than in groups C and L (no response, P < 0.001; severe response, P < 0.001). CONCLUSIONS Pretreatment with inhaled N(2)O can reduce the pain associated with propofol and rocuronium injection. Moreover, N(2)O (with or without lidocaine) is more effective than lidocaine alone in reducing rocuronium-related withdrawal reactions associated with sequential injection of propofol and rocuronium.
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Affiliation(s)
- Eunsoo Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea,
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16
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Kim EJ, Shin SW, Kim TK, Yoon JU, Byeon GJ, Kim HJ. The median effective effect-site concentration of remifentanil for minimizing the cardiovascular changes to endotracheal intubation during desflurane anesthesia in pediatric patients. Korean J Anesthesiol 2012; 63:314-20. [PMID: 23115683 PMCID: PMC3483489 DOI: 10.4097/kjae.2012.63.4.314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 05/11/2012] [Accepted: 05/16/2012] [Indexed: 11/10/2022] Open
Abstract
Background Desflurane has the most rapid onset and offset of action among the volatile anesthetic agents used for general anesthesia, but it can cause airway reactivity, tachycardia, and hypertension during induction, especially in pediatric patients. This study was designed to determine a median effective effect-site concentration (EC50) of remifentanil to prevent the cardiovascular changes due to tracheal intubation during the 1 minimum alveolar concentration (MAC) desflurane inhalation, which was required to prevent movement in response to a noxious stimulus in 50% of subjects, in pediatric patients. Methods Twenty-four pediatric patients between the ages 5-15 years were enrolled in this study. We injected thiopental intravenously, at the same time remifentanil was infused by Target Controlled Infusion (TCI) device. When the target effect-site concentration (Ce) of remifentanil reached a preset level, desflurane was administrated through the facial mask. Then, we assessed the signs of desflurane related airway reactivity and cardiovascular changes for 2 min. The up-and-down criteria was a 20% change in systolic blood pressure (SBP) and a heart rate (HR) between just prior to intubation and 1 min after intubation. The EC50 of remifentanil was calculated from 8 independent pairs using Dixon's up-and-down method. Results We studied 24 pediatric patients in range of 1-5 ng/ml of the Ce of remifentanil. No patient showed airway reactivity during the study. The EC50 of remifentanil to suppress the hemodynamic changes after tracheal intubation during desflurane anesthesia was calculated as 3.4 ± 0.9 ng/ml. Conclusions In pediatric anesthesia, the EC50 of remifentanil to minimize the cardiovascular changes due to tracheal intubation during 1 MAC desflurane anesthesia was 3.4 ± 0.9 ng/ml.
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Affiliation(s)
- Eun-Jung Kim
- Department of Anesthesiology and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
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17
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Sharma S, Sharma D, Jain A, Jain A. Effect of nitrous oxide on pain due to rocuronium injection: A randomised, double-blind, controlled clinical trial. Indian J Anaesth 2011; 54:142-6. [PMID: 20661353 PMCID: PMC2900738 DOI: 10.4103/0019-5049.63660] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A prospective, randomised, double-blind, placebo-controlled study was carried out to determine the effect of nitrous oxide (N2O) on the frequency and severity of pain and withdrawal reactions after injection of rocuronium. Eighty ASA physical status I and II patients undergoing general anaesthesia for elective surgery were enrolled. The patients were randomised to receive 100% oxygen (O2), or 50% N2O in O2 for 3 minutes followed by a subparalysing dose of rocuronium 0.06 mg/kg. After induction of anaesthesia with thiopentone 5 mg/kg, an intubating dose of rocuronium 0.6 mg/kg was given. The patients were observed after injection of rocuronium 0.06 mg/kg, and asked to rate pain in the arm on a 4-point (0–3) verbal rating scale (none, mild, moderate or severe). After the intubating dose of rocuronium, withdrawal reactions were recorded. Thirty-six patients (90%) in the group N2O and 15 patients (37.5%) in the group O2 reported no pain (P < 0.001). The pain was mild in 1 (2.5%) and 9 (22.5%) patients in N2O and O2 groups, respectively (P = 0.006). Moderate pain occurred in 2 (5%) patients in group N2O and 15 (37.5%) patients in group O2 (P = 0.001). Severe pain was reported by one patient in each group (P = 0.47). Withdrawal response after an intubating dose of rocuronium was observed in 6 (15%) and 18 (45%) patients in the N2O and O2 groups, respectively (P < 0.05). Inhalation of 50% N2O in O2 reduces the incidence and severity of pain and the withdrawal reactions associated with rocuronium injection.
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Affiliation(s)
- Sonal Sharma
- Department of Anesthesiology, SDM Hospital, Jaipur, Rajasthan, India
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18
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Mahajan C, Rath GP, Bithal PK, Prabhakar H, Yadav R, Dube SK. Local warming at injection site helps alleviate pain after rocuronium administration. J Anesth 2010; 24:845-8. [PMID: 20737278 DOI: 10.1007/s00540-010-1014-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 08/02/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE Various strategies have been proposed to reduce discomfort of pain after rocuronium injection. These studies have shown pretreatment of drugs such as fentanyl and lidocaine to be effective. In a prospective randomized study, we evaluated whether pretreatment with local warming at injection site using an air-warming device could effectively alleviate pain induced by rocuronium. METHODS Ninety patients undergoing spinal surgeries were randomly divided into two groups: group C (control) and group T (treatment). Patients in group T were subjected to warming at 40°C for 1 min prior to injecting 1 ml (10 mg) of rocuronium at the site of venous access. Patients were then assessed for any discomfort and to quantify their discomfort on a 5-point scale. RESULTS Age, sex, and weight were comparable between the two groups. Pain on rocuronium administration was reported by 88.9% patient in group C versus 66.7% in group T (p < 0.05). Severe pain was significantly less in group T (35.6% vs. 8.9%). CONCLUSION Application of warmth over the vascular access prior to rocuronium administration effectively reduces injection-related pain.
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Affiliation(s)
- Charu Mahajan
- Department of Neuroanaesthesiology, Neurosciences Center, Room No. 711, All India Institute of Medical Sciences, New Delhi 110029, India
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Jeon Y, Baek SU, Park SS, Kim SO, Baek WY, Yeo JS. Effect of pretreatment with acetaminophen on withdrawal movements associated with injection of rocuronium: a prospective, randomized, double-blind, placebo controlled study. Korean J Anesthesiol 2010; 59:13-6. [PMID: 20651992 PMCID: PMC2908220 DOI: 10.4097/kjae.2010.59.1.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 03/11/2010] [Accepted: 04/19/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Withdrawal movement during rocuronium injection is a common, unresolved adverse effect. We aimed to investigate the effect of IV acetaminophen pretreatment on withdrawal movement during rocuronium injection. METHODS This study enrolled 120 American Society of Anesthesiologists (ASA) I-II patients undergoing general anesthesia. They were randomly assigned to three treatment groups. After occluding venous drainage using a tourniquet on the upper arm, the saline group received 5 ml of 0.9% sodium chloride solution, the lidocaine group received 40 mg of lidocaine, and the acetaminophen group received 50 mg of acetaminophen. During injection of pretreatment drug, pain was assessed on a four-point scale. The tourniquet was released after 120 seconds and anesthesia was performed using thiopental sodium 5 mg/kg followed by rocuronium 0.6 mg/kg. The withdrawal movement was graded on a four-point scale in a double-blind manner. RESULTS The incidence of pain on pretreatment injection in saline, lidocaine, and acetaminophen groups was 7.7%, 5.1%, and 2.5%, respectively. The incidence of withdrawal movements was 77.5% in saline group, 32.5% in lidocaine group, and 37.5% in acetaminophen group (P < 0.05). CONCLUSIONS Acetaminophen and lidocaine reduced the incidence of withdrawal movement after rocuronium injection compared with saline.
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Affiliation(s)
- Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Kim YH, Go YK, Lee JU, Chung WS, Shin YS, Han KC, Shin JE, Lee SH. Pretreatment with nafamostat mesilate, a kallikrein inhibitor, to decrease withdrawal response associated with rocuronium. J Anesth 2010; 24:549-52. [PMID: 20499255 DOI: 10.1007/s00540-010-0964-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 04/20/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE This randomized, double-blind, placebo-controlled study was conducted to examine the preventive effect of nafamostat mesilate, a kallikrein inhibitor, on the withdrawal response associated with rocuronium injection. METHODS Ninety American Society of Anesthesiology (ASA) physical status I or II patients, aged 18-65 years, were randomly divided into two groups that received either a 1.5-ml solution containing 1.5 mg nafamostat mesilate diluted in a 5% glucose solution or a 1.5-ml 5% glucose solution. Anesthesia was induced by 5 mg/kg 2.5% thiopental. After confirming loss of consciousness, a tourniquet was applied to the mid forearm and tightened to block venous flow. The test solution was then administered, 1 min after which the tourniquet was removed and 0.6 mg/kg rocuronium was administered. Each patient's response to rocuronium injection was graded on a four-point scale in a double-blind manner. Activated coagulation time and plasma potassium concentration were measured before and 5 and 10 min after nafamostat administration. RESULTS The incidence of withdrawal response was 68.9% in the control group and 24.4% in the nafamostat group (P < 0.001). The number of patients showing generalized movement (response 4) with the rocuronium injection was significantly lower in nafamostat group [1 (2.2%)] than the control group [15 (33.3%)], P < 0.001. Five and 10 min after nafamostat administration, measured potassium and activated coagulation time were similar to baseline values. CONCLUSION Pretreatment with 1.5 mg nafamostat mesilate decreased withdrawal response associated with rocuronium injection.
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Affiliation(s)
- Yoon Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 640 Daesa-dong, Jung-gu, Daejeon, 301-721, Korea.
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Eyigor C, Ceylan A, Demir F, Ayanoglu HO, Ugur G. Superficial venous thrombophlebitis caused by rocuronium. J Anesth 2010; 24:646-8. [PMID: 20411396 DOI: 10.1007/s00540-010-0944-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 03/29/2010] [Indexed: 11/26/2022]
Abstract
Pain is one of the major disadvantages of rocuronium, which is used during induction of anesthesia. Even at subparalyzing doses, 50-100% of patients complain of intense pain. Sudden flexion and withdrawal movement in the wrist or arm have been reported following rocuronium use in many papers. No information about risk factors leading to this withdrawal movement or pain on injection is available and whether this reaction leads to erythema or to venous sequelae (i.e. thrombosis and thrombophlebitis) has not been systematically investigated. However, in both of our cases, visible reactions occurred and both patients were diagnosed with venous superficial thrombophlebitis. Therefore, we believe that rocuronium-related pain may, in part, be because of direct venous injury.
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Affiliation(s)
- Can Eyigor
- Anesthesiology Department, Faculty of Medicine, Pain Clinic, Ege University, 35100, Bornova, Izmir, Turkey.
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Park SJ, Park HJ, Choi JY, Kang HS, Choi HS. The influence of age and gender on remifentanil EC(50) for preventing rocuronium induced withdrawal movements. Korean J Anesthesiol 2010; 58:244-8. [PMID: 20498772 PMCID: PMC2872841 DOI: 10.4097/kjae.2010.58.3.244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 12/29/2009] [Accepted: 02/02/2010] [Indexed: 11/10/2022] Open
Abstract
Background Rocuronium-induced withdrawal movements can be harmful to patients during the induction period. Remifentanil has been reported to reduce these movements effectively. In this study, we determined the EC50 of remifentanil for the prevention of rocuronium induced withdrawal movements in male, female, old and child group. Methods We included patients scheduled for general anesthesia and assigned them into 4 groups depending on their age and gender: male group (20-60 yr), female group (20-60 yr), old group (>65 yr) and child group (6-12 yr). Remifentanil was administered by target controlled infusion. Propofol 2 mg/kg was then administered after equilibration between the effect and plasma concentration of remifentanil was reached. After loss of consciousness, rocuronium 0.6 mg/kg was administered. Patient's response to the rocuronium was graded using a 4 point scale in a blinded manner. The EC50 of remifentanil for preventing rocuronium induced withdrawal movements was determined using Dixon's up-and -down method. Results The EC50 of remifentanil for preventing rocuronium induced withdrawal movements was 1.8 ± 0.5 ng/ml [95% confidence interval 1.3-2.2] in the male group, 2.3 ± 1.0 ng/ml [1.3-3.2] in the female group, 0.5 ± 0.4 ng/ml [0.2-0.8] in the old group and 2.8 ± 0.8 ng/ml [2.1-3.5] in the child group. Conclusions The EC50 of remifentanil for preventing rocuronium induced withdrawal movements was lowest in the elderly and higher in children than male adult patients. No difference in the EC50 of remifentanil was seen between male and female adult patients.
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Affiliation(s)
- So Jin Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Eulji University, Eulji Hospital, Seoul, Korea
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Lee HJ, Han SJ, Kim H, Lee IO, Kong MH, Kim NS, Lim SH, Lee MK. Antihistamine pretreatment to reduce incidence of withdrawal movement after rocuronium injection. J Korean Med Sci 2009; 24:879-82. [PMID: 19794987 PMCID: PMC2752772 DOI: 10.3346/jkms.2009.24.5.879] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 10/22/2008] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Ho Jun Lee
- Department of Anesthesiology and Pain Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Baek SH, Woo CM, Lee HJ, Yoon JY, Kwon JY, Shin SW. Rocuronium-induced withdrawal movements associated with different Rocuronium injection method. Paediatr Anaesth 2008; 18:515-9. [PMID: 18312520 DOI: 10.1111/j.1460-9592.2008.02465.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES One hundred and twenty patients (3-15 years old) were randomly enrolled (four groups: each group = 30 patients) in the study. AIM The aim of this study was to compare the incidence and intensity of rocuronium-induced withdrawal movements in children injected with a typical intravenous bolus injection of rocuronium or with an infusion injection of rocuronium. BACKGROUND Intravenous bolus injection of rocuronium produces pain and withdrawal movement. METHODS Immediately after loss of consciousness by thiopental sodium (5 mg x kg(-1)), 0.6 mg x kg(-1) (B0.6, I0.6) or 0.9 mg x kg(-1) rocuronium (B0.9, I0.9) was injected by different method, either a bolus injection over 5 s (B0.6, B0.9) or an infusion injection lasting for 1 min (I0.6, I0.9). The withdrawal movement of the patients to the injection of rocuronium was assessed (four-grade score: 0-3). Intubating condition was assessed. Rocuronium-induced muscle relaxation time was measured by single twitch stimulation fade out. RESULTS The incidence (group B: 100%, group I: 33.3%) and the intensity of the withdrawal movements were significantly lower in the infusion groups compared with the bolus groups (P < 0.05). The intubating conditions for all groups were clinically acceptable (good to excellent). There was no significant difference in the muscle relaxation time between the different injection groups (I0.6; 105.6 +/- 7.7 vs B0.6; 114.6 +/- 8.0, I0.9; 69.2 +/- 3.6 vs B0.9; 73.4 +/- 1/0). CONCLUSIONS The infusion injection of rocuronium for tracheal intubation significantly reduced the incidence and intensity of withdrawal movement on injection of rocuronium, and it neither delays the onset of muscle relaxation nor deteriorates the intubating condition.
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Affiliation(s)
- Seung-Hoon Baek
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
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Park JT, Choi JC, Yoo YS, Lee YB, Kim SY, Lim HK. The effect of pretreatment with thiopental on reducing pain induced by rocuronium injection. Yonsei Med J 2005; 46:765-8. [PMID: 16385651 PMCID: PMC2810589 DOI: 10.3349/ymj.2005.46.6.765] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Jong-Taek Park
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae-Chan Choi
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young-Soo Yoo
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young-Bok Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Soon-Yul Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun-Kyo Lim
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Abstract
Neuromuscular blocking agents (NMBAs) play a predominant role in the incidence of severe adverse reactions occurring during anesthesia. Most hypersensitivity reactions are of immunologic origin (IgE-mediated) or are related to direct stimulation of histamine release. The incidence of IgE-mediated hypersensitivity or anaphylaxis is estimated between 1 in 10,000 and 1 in 20,000 anesthesias, and NMBAs represent the most frequently involved substances, with a range of 50% to 70%. Any suspected anaphylactic reaction must be extensively investigated using combined perioperative and postoperative testing. Because of the frequent cross-reactivity observed with muscle relaxants, every available NMBA should be tested. This should help provide documented advice for future administration of anesthesia. There is no demonstrated evidence for systematic preoperative screening in the general population at this time. Other well-known adverse effects have been described, such as the succinylcholine-triggered cytotoxic effects on muscle cells, but these are responsible for characteristic clinical symptoms, which are usually easy to distinguish from anaphylactic reactions
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Affiliation(s)
- Paul-Michel Mertes
- Département d'Anesthésie-réanimation, CHU de Nancy, Hôpital Central, 29 Avenue de Lattre de Tassigny, 54035 Nancy Cedex, France.
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