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Infusion dose requirement of rocuronium in patients on phenytoin therapy – A prospective comparative study

BACKGROUND AND AIMS: Patients with intracranial tumour are usually on anticonvulsants. Patients on phenytoin therapy demonstrate rapid metabolism of nondepolarising muscle relaxants secondary to enzyme induction. Infusion dose requirement of rocuronium in such patients has been sparingly studied. We...

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Autores principales: Sheshadri, Veena, Radhakrishnan, Arathi, Halemani, Kusuma, Keshavan, Venkatesh H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664883/
https://www.ncbi.nlm.nih.gov/pubmed/29242650
http://dx.doi.org/10.4103/ija.IJA_218_17
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author Sheshadri, Veena
Radhakrishnan, Arathi
Halemani, Kusuma
Keshavan, Venkatesh H
author_facet Sheshadri, Veena
Radhakrishnan, Arathi
Halemani, Kusuma
Keshavan, Venkatesh H
author_sort Sheshadri, Veena
collection PubMed
description BACKGROUND AND AIMS: Patients with intracranial tumour are usually on anticonvulsants. Patients on phenytoin therapy demonstrate rapid metabolism of nondepolarising muscle relaxants secondary to enzyme induction. Infusion dose requirement of rocuronium in such patients has been sparingly studied. We studied the continuous infusion dose requirement of rocuronium bromide in patients on phenytoin therapy and its correlation with serum levels of phenytoin. METHODS: Seventy-five patients scheduled for supratentorial tumour surgery were included in the study. Patients not on phenytoin were taken as control. The primary outcome variable studied was the infusion dose requirement of rocuronium in patients on phenytoin. Based on pre-operative serum phenytoin levels, study group patients were divided into two groups: sub-therapeutic level group (phenytoin level <10 μg/mL) and therapeutic level group (phenytoin level >10 μg/mL). Following anaesthesia induction, rocuronium bromide 0.6 mg/kg was administered to achieve tracheal intubation. Rocuronium infusion was titrated to maintain zero response on the train-of-four response. RESULTS: Demographic data were comparable. Patients receiving phenytoin required higher infusion dose compared to the control group (0.429 ± 0.2 mg/kg/h vs. 0.265 ± 0.15 mg/kg/h, P < 0.001). The serum phenytoin level had no correlation to infusion dose requirement of rocuronium (0.429 ± 0.205 mg/kg/h vs. 0.429 ± 0.265 mg/kg/h (P = 0.815). The recovery was faster in the phenytoin group compared to the control group. Haowever, it was not clinically significant. CONCLUSION: The infusion dose requirement of rocuronium bromide in patients on phenytoin is higher and the serum levels of phenytoin does not influence the dose required.
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spelling pubmed-56648832017-12-14 Infusion dose requirement of rocuronium in patients on phenytoin therapy – A prospective comparative study Sheshadri, Veena Radhakrishnan, Arathi Halemani, Kusuma Keshavan, Venkatesh H Indian J Anaesth Original Article BACKGROUND AND AIMS: Patients with intracranial tumour are usually on anticonvulsants. Patients on phenytoin therapy demonstrate rapid metabolism of nondepolarising muscle relaxants secondary to enzyme induction. Infusion dose requirement of rocuronium in such patients has been sparingly studied. We studied the continuous infusion dose requirement of rocuronium bromide in patients on phenytoin therapy and its correlation with serum levels of phenytoin. METHODS: Seventy-five patients scheduled for supratentorial tumour surgery were included in the study. Patients not on phenytoin were taken as control. The primary outcome variable studied was the infusion dose requirement of rocuronium in patients on phenytoin. Based on pre-operative serum phenytoin levels, study group patients were divided into two groups: sub-therapeutic level group (phenytoin level <10 μg/mL) and therapeutic level group (phenytoin level >10 μg/mL). Following anaesthesia induction, rocuronium bromide 0.6 mg/kg was administered to achieve tracheal intubation. Rocuronium infusion was titrated to maintain zero response on the train-of-four response. RESULTS: Demographic data were comparable. Patients receiving phenytoin required higher infusion dose compared to the control group (0.429 ± 0.2 mg/kg/h vs. 0.265 ± 0.15 mg/kg/h, P < 0.001). The serum phenytoin level had no correlation to infusion dose requirement of rocuronium (0.429 ± 0.205 mg/kg/h vs. 0.429 ± 0.265 mg/kg/h (P = 0.815). The recovery was faster in the phenytoin group compared to the control group. Haowever, it was not clinically significant. CONCLUSION: The infusion dose requirement of rocuronium bromide in patients on phenytoin is higher and the serum levels of phenytoin does not influence the dose required. Medknow Publications & Media Pvt Ltd 2017-10 /pmc/articles/PMC5664883/ /pubmed/29242650 http://dx.doi.org/10.4103/ija.IJA_218_17 Text en Copyright: © 2017 Indian Journal of Anaesthesia http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Sheshadri, Veena
Radhakrishnan, Arathi
Halemani, Kusuma
Keshavan, Venkatesh H
Infusion dose requirement of rocuronium in patients on phenytoin therapy – A prospective comparative study
title Infusion dose requirement of rocuronium in patients on phenytoin therapy – A prospective comparative study
title_full Infusion dose requirement of rocuronium in patients on phenytoin therapy – A prospective comparative study
title_fullStr Infusion dose requirement of rocuronium in patients on phenytoin therapy – A prospective comparative study
title_full_unstemmed Infusion dose requirement of rocuronium in patients on phenytoin therapy – A prospective comparative study
title_short Infusion dose requirement of rocuronium in patients on phenytoin therapy – A prospective comparative study
title_sort infusion dose requirement of rocuronium in patients on phenytoin therapy – a prospective comparative study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664883/
https://www.ncbi.nlm.nih.gov/pubmed/29242650
http://dx.doi.org/10.4103/ija.IJA_218_17
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