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High-dose rocuronium-induced paralysis of the adductor pollicis muscle facilitates detection of the timing for tracheal intubation in elderly patients: a randomized double-blind study

PURPOSE: To prevent coughing related to tracheal intubation and the resultant exposure of intubating staff to the patients’ expiratory aerosols, the timing of tracheal intubation needs to be precisely predicted. The aim of this study was to evaluate the hypothesis that the timing for safe tracheal i...

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Autores principales: Takagi, Shunichi, Sugaya, Nami, Kiuchi, Naoto, Iwasa, Aya, Itagaki, Masumi, Seki, Aya, Suzuki, Junko, Suzuki, Takahiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Singapore 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377532/
https://www.ncbi.nlm.nih.gov/pubmed/32705417
http://dx.doi.org/10.1007/s00540-020-02831-6
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author Takagi, Shunichi
Sugaya, Nami
Kiuchi, Naoto
Iwasa, Aya
Itagaki, Masumi
Seki, Aya
Suzuki, Junko
Suzuki, Takahiro
author_facet Takagi, Shunichi
Sugaya, Nami
Kiuchi, Naoto
Iwasa, Aya
Itagaki, Masumi
Seki, Aya
Suzuki, Junko
Suzuki, Takahiro
author_sort Takagi, Shunichi
collection PubMed
description PURPOSE: To prevent coughing related to tracheal intubation and the resultant exposure of intubating staff to the patients’ expiratory aerosols, the timing of tracheal intubation needs to be precisely predicted. The aim of this study was to evaluate the hypothesis that the timing for safe tracheal intubation in elderly patients can be determined by acceleromyographically monitoring paralysis of the adductor pollicis muscle when high-dose rocuronium, given to block the respiratory muscles, is administered. METHODS: Forty elderly (65–92 years) patients were enrolled in this study and randomly assigned to two groups, to receive rocuronium 0.6 mg/kg or 1 mg/kg. After induction of anesthesia and observing acceleromyographic train-of-four (TOF) responses of the adductor pollicis muscle to ulnar nerve stimulation, the patients randomly received either dose of rocuronium. The onset times from rocuronium administration to TOF counts of 0 were measured. Soon thereafter, a single anesthesiologist who was blinded to the allocated dose of rocuronium performed laryngoscopy and tracheal intubation, and assessed intubating conditions. Data were analyzed by the unpaired t-test and Chi-squared test. RESULTS: The averaged [SD] onset time of neuromuscular blockade was significantly shorter with 1 mg/kg than 0.6 mg/kg rocuronium (104.3 [30.1] s vs. 186.8 [37.5] s, p < 0.001). Patients who received 0.6 mg/kg rocuronium variously showed either poor (n = 9) or good (n = 11) intubating conditions. However, all patients who received 1 mg/kg rocuronium had excellent intubating conditions. CONCLUSIONS: If 1 mg/kg rocuronium is administered, a TOF count of 0 acceleromyographically observed at the adductor pollicis muscle can reveal the adequate timing for tracheal intubation.
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spelling pubmed-73775322020-07-24 High-dose rocuronium-induced paralysis of the adductor pollicis muscle facilitates detection of the timing for tracheal intubation in elderly patients: a randomized double-blind study Takagi, Shunichi Sugaya, Nami Kiuchi, Naoto Iwasa, Aya Itagaki, Masumi Seki, Aya Suzuki, Junko Suzuki, Takahiro J Anesth Original Article PURPOSE: To prevent coughing related to tracheal intubation and the resultant exposure of intubating staff to the patients’ expiratory aerosols, the timing of tracheal intubation needs to be precisely predicted. The aim of this study was to evaluate the hypothesis that the timing for safe tracheal intubation in elderly patients can be determined by acceleromyographically monitoring paralysis of the adductor pollicis muscle when high-dose rocuronium, given to block the respiratory muscles, is administered. METHODS: Forty elderly (65–92 years) patients were enrolled in this study and randomly assigned to two groups, to receive rocuronium 0.6 mg/kg or 1 mg/kg. After induction of anesthesia and observing acceleromyographic train-of-four (TOF) responses of the adductor pollicis muscle to ulnar nerve stimulation, the patients randomly received either dose of rocuronium. The onset times from rocuronium administration to TOF counts of 0 were measured. Soon thereafter, a single anesthesiologist who was blinded to the allocated dose of rocuronium performed laryngoscopy and tracheal intubation, and assessed intubating conditions. Data were analyzed by the unpaired t-test and Chi-squared test. RESULTS: The averaged [SD] onset time of neuromuscular blockade was significantly shorter with 1 mg/kg than 0.6 mg/kg rocuronium (104.3 [30.1] s vs. 186.8 [37.5] s, p < 0.001). Patients who received 0.6 mg/kg rocuronium variously showed either poor (n = 9) or good (n = 11) intubating conditions. However, all patients who received 1 mg/kg rocuronium had excellent intubating conditions. CONCLUSIONS: If 1 mg/kg rocuronium is administered, a TOF count of 0 acceleromyographically observed at the adductor pollicis muscle can reveal the adequate timing for tracheal intubation. Springer Singapore 2020-07-23 2020 /pmc/articles/PMC7377532/ /pubmed/32705417 http://dx.doi.org/10.1007/s00540-020-02831-6 Text en © Japanese Society of Anesthesiologists 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Article
Takagi, Shunichi
Sugaya, Nami
Kiuchi, Naoto
Iwasa, Aya
Itagaki, Masumi
Seki, Aya
Suzuki, Junko
Suzuki, Takahiro
High-dose rocuronium-induced paralysis of the adductor pollicis muscle facilitates detection of the timing for tracheal intubation in elderly patients: a randomized double-blind study
title High-dose rocuronium-induced paralysis of the adductor pollicis muscle facilitates detection of the timing for tracheal intubation in elderly patients: a randomized double-blind study
title_full High-dose rocuronium-induced paralysis of the adductor pollicis muscle facilitates detection of the timing for tracheal intubation in elderly patients: a randomized double-blind study
title_fullStr High-dose rocuronium-induced paralysis of the adductor pollicis muscle facilitates detection of the timing for tracheal intubation in elderly patients: a randomized double-blind study
title_full_unstemmed High-dose rocuronium-induced paralysis of the adductor pollicis muscle facilitates detection of the timing for tracheal intubation in elderly patients: a randomized double-blind study
title_short High-dose rocuronium-induced paralysis of the adductor pollicis muscle facilitates detection of the timing for tracheal intubation in elderly patients: a randomized double-blind study
title_sort high-dose rocuronium-induced paralysis of the adductor pollicis muscle facilitates detection of the timing for tracheal intubation in elderly patients: a randomized double-blind study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377532/
https://www.ncbi.nlm.nih.gov/pubmed/32705417
http://dx.doi.org/10.1007/s00540-020-02831-6
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