.: ORİJİNAL ARAŞTIRMA
Retrospective Comparison of the Effects of Total Intravenous Anesthesia and Sevoflurane Anesthesia on the Clinical Duration of Action of Rocuronium in Diabetic and Non-Diabetic Patients: Retrospective Observational Study
Diyabetik ve Non-Diyabetik Hastalarda Total İntravenöz Anestezi ve Sevofluran Anestezisinin Rokuronyumun Klinik Etki Süresi Üzerine Olan Etkilerinin Retrospektif Olarak Karşılaştırılması: Retrospektif Gözlemsel Çalışma
Turkiye Klinikleri J Anest Reanim. 2022;20(3):105-10
doi: 10.5336/anesthe.2022-92249
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Due to the decrease in nerve conduction velocity, the clinical effect of rocuronium may be prolonged in diabetic patients receiving inhalation anesthesia, and its postoperative residual muscle relaxant effect may lead to complications. We compared the effects of total intravenous anesthesia and sevoflurane anesthesia on the clinical duration of action of rocuronium in diabetic and nondiabetic patients. Material and Methods: Patients between the ages of 18-65, who underwent general anesthesia for elective surgery in the general surgery department of our hospital (0.6 mg of rocuronium was used for tracheal intubation), with Type 2 diabetes and with the American Society of Anesthesiologists Physical Condition Classification (ASA) I-II were included in the study. Non-diabetic patients (ASA I-II) of the same age were included in the study as the control group. The duration of the clinical effect of rocuronium between the time of administration of the first dose of rocuronium and the time of administration of the additional rocuronium dose (time recorded in TOFcount 2-TOFc2) was evaluated. Results: The clinical duration of action of rocuronium was longer in both diabetic groups than in nondiabetic groups (p=0.000). When the diabetic patient groups were compared, the clinical duration of action of rocuronium was longer in the diabetic sevoflurane group than in the diabetic group that received total intravenous anesthesia (p=0.012). Conclusion: It was determined that the duration of rocuronium action was longer in diabetic patients who were administered sevoflurane anesthesia than in patients who received total intravenous anesthesia and in non-diabetic patients.
Keywords: Rocuronium; sevoflurane; diabetes mellitus; neuromuscular monitoring
Objective: Due to the decrease in nerve conduction velocity, the clinical effect of rocuronium may be prolonged in diabetic patients receiving inhalation anesthesia, and its postoperative residual muscle relaxant effect may lead to complications. We compared the effects of total intravenous anesthesia and sevoflurane anesthesia on the clinical duration of action of rocuronium in diabetic and nondiabetic patients. Material and Methods: Patients between the ages of 18-65, who underwent general anesthesia for elective surgery in the general surgery department of our hospital (0.6 mg of rocuronium was used for tracheal intubation), with Type 2 diabetes and with the American Society of Anesthesiologists Physical Condition Classification (ASA) I-II were included in the study. Non-diabetic patients (ASA I-II) of the same age were included in the study as the control group. The duration of the clinical effect of rocuronium between the time of administration of the first dose of rocuronium and the time of administration of the additional rocuronium dose (time recorded in TOFcount 2-TOFc2) was evaluated. Results: The clinical duration of action of rocuronium was longer in both diabetic groups than in nondiabetic groups (p=0.000). When the diabetic patient groups were compared, the clinical duration of action of rocuronium was longer in the diabetic sevoflurane group than in the diabetic group that received total intravenous anesthesia (p=0.012). Conclusion: It was determined that the duration of rocuronium action was longer in diabetic patients who were administered sevoflurane anesthesia than in patients who received total intravenous anesthesia and in non-diabetic patients.
Keywords: Rocuronium; sevoflurane; diabetes mellitus; neuromuscular monitoring
ÖZET
Amaç: İnhalasyon anestezisi alan diyabetik hastalarda, sinir iletim hızındaki azalma nedeniyle rokuronyumun klinik etkisi uzayabilmekte ve postoperatif rezidüel kas gevşetici etkisi komplikasyonlara neden olabilmektedir. Diyabetik ve diyabetik olmayan hastalarda total intravenöz anestezi ve sevofluran anestezisinin rokuronyumun klinik etki süresi üzerindeki etkilerini karşılaştırdık. Gereç ve Yöntemler: Hastanemiz genel cerrahi bölümünde, elektif cerrahi için genel anestezi uygulanan (trakeal entübasyon için 0,6 mg rokuronyum kullanılan) 18-65 yaşları arasında Tip 2 diyabetli, Amerikan Anesteziyologlar Derneği Fiziksel Durum Sınıflandırması [American Society of Anesthesiologists Physical Condition Classification (ASA)] II olan hastalar çalışmaya dâhil edildi. Aynı yaş aralıklı non-diyabetik hastalar (ASA Ⅰ-Ⅱ) kontrol grubu olarak çalışmaya dâhil edildi. İlk doz rokuronyum uygulama zamanı ile ek rokuronyum dozunun uygulama zamanı (TOFcount 2'de-TOFc2 kaydedilen süre) arasındaki rokuronyumun klinik etkisinin süresi değerlendirildi. Bulgular: Rokuronyumun klinik etki süresi her iki diyabetik grupta diyabetik olmayan gruplara göre daha uzun bulundu (p=0,000). Diyabetik hasta grupları karşılaştırıldığında, diyabetik sevofluran grubunda rokuronyumun klinik etki süresi diyabetik total intravenöz anestezi almış gruba göre daha uzundu (p=0,012). Sonuç: Sevofluran anestezisi uygulanan diyabetik hastalarda, rokuronyum etki süresinin total intravenöz anestezi uygulanan hastalara ve diyabetik olmayanlara göre daha uzun olduğu saptandı.
Anahtar Kelimeler: Rokuronyum; sevofluran; diabetes mellitus; nöromusküler monitörizasyon
Amaç: İnhalasyon anestezisi alan diyabetik hastalarda, sinir iletim hızındaki azalma nedeniyle rokuronyumun klinik etkisi uzayabilmekte ve postoperatif rezidüel kas gevşetici etkisi komplikasyonlara neden olabilmektedir. Diyabetik ve diyabetik olmayan hastalarda total intravenöz anestezi ve sevofluran anestezisinin rokuronyumun klinik etki süresi üzerindeki etkilerini karşılaştırdık. Gereç ve Yöntemler: Hastanemiz genel cerrahi bölümünde, elektif cerrahi için genel anestezi uygulanan (trakeal entübasyon için 0,6 mg rokuronyum kullanılan) 18-65 yaşları arasında Tip 2 diyabetli, Amerikan Anesteziyologlar Derneği Fiziksel Durum Sınıflandırması [American Society of Anesthesiologists Physical Condition Classification (ASA)] II olan hastalar çalışmaya dâhil edildi. Aynı yaş aralıklı non-diyabetik hastalar (ASA Ⅰ-Ⅱ) kontrol grubu olarak çalışmaya dâhil edildi. İlk doz rokuronyum uygulama zamanı ile ek rokuronyum dozunun uygulama zamanı (TOFcount 2'de-TOFc2 kaydedilen süre) arasındaki rokuronyumun klinik etkisinin süresi değerlendirildi. Bulgular: Rokuronyumun klinik etki süresi her iki diyabetik grupta diyabetik olmayan gruplara göre daha uzun bulundu (p=0,000). Diyabetik hasta grupları karşılaştırıldığında, diyabetik sevofluran grubunda rokuronyumun klinik etki süresi diyabetik total intravenöz anestezi almış gruba göre daha uzundu (p=0,012). Sonuç: Sevofluran anestezisi uygulanan diyabetik hastalarda, rokuronyum etki süresinin total intravenöz anestezi uygulanan hastalara ve diyabetik olmayanlara göre daha uzun olduğu saptandı.
Anahtar Kelimeler: Rokuronyum; sevofluran; diabetes mellitus; nöromusküler monitörizasyon
REFERANSLAR:
- Senapati LK, Battini KP, Padhi PP, Samanta P. Effect of non-depolarizing muscle relaxants rocuronium versus vecuronium in the assessment of post-succinylcholine complications in surgeries under general anesthesia: a randomized double-blind study at a tertiary care hospital. Cureus. 2021;13(11):e19793. [Crossref] [PubMed] [PMC]
- Rao MH, Venkatraman A, Mallleswari R. Comparison of intubating conditions between rocuronium with priming and without priming: randomized and double-blind study. Indian J Anaesth. 2011;55(5):494-8. [Crossref] [PubMed] [PMC]
- Khuenl-Brady KS, Sparr H. Clinical pharmacokinetics of rocuronium bromide. Clin Pharmacokinet. 1996;31(3):174-83. [Crossref] [PubMed]
- Saitoh Y, Hattori H, Sanbe N, Nakajima H, Akatu M, Murakawa M. Delayed recovery of vecuronium neuromuscular block in diabetic patients during sevoflurane anesthesia. Can J Anaesth. 2005;52(5):467-73. [Crossref] [PubMed]
- Wulf H, Ledowski T, Linstedt U, Proppe D, Sitzlack D. Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia. Can J Anaesth. 1998;45(6):526-32. [Crossref] [PubMed]
- Meretoja OA, Wirtavuori K, Taivainen T, Olkkola KT. Time course of potentiation of mivacurium by halothane and isoflurane in children. Br J Anaesth. 1996;76(2):235-8. [Crossref] [PubMed]
- Topal A, Sargin M, Et T, Uzun ST. Diyabetik vakalarda roküronyumun nöromusküler blok özellikleri [Neuromuscular characteristics of rocuronium in diabetic patients]. Cukurova Med J. 2014;39(4):807-13. [Link]
- Nitahara K, Sugi Y, Shigematsu K, Haraga I, Abe S, Higa K. Recovery of train-of-four ratio to 0.70 and 0.90 is delayed in type 2 diabetes with vecuronium-induced neuromuscular block. Eur J Anaesthesiol. 2013;30(2):80-4. [Crossref] [PubMed]
- Armendáriz-Buil I, Lobato-Solores F, Aguilera-Celorrio L, Morros-Díaz E, Fraile-Jiménez E, Vera-Bella J. Residual neuromuscular block in type II diabetes mellitus after rocuronium: a prospective observational study. Eur J Anaesthesiol. 2014;31(8):411-6. [Crossref] [PubMed]
- Şahin A, Ankay Yılbaş A, Pamuk AG, Akça B, Üzümcügil F, Çelebi N. Type II diabetes mellitus prolongs rocuronium induced neuromuscular blockade irrespective of glycaemic control. Acta Medica. 2019;50(1). [Crossref]
- Casey EB, Harrison MJ. Diabetic amyotrophy: a follow-up study. Br Med J. 1972;1(5801):656-9. [Crossref] [PubMed] [PMC]
- Bansal V, Kalita J, Misra UK. Diabetic neuropathy. Postgrad Med J. 2006;82(964):95-100. [Crossref] [PubMed] [PMC]
- Van Slyke MA, Ostrov BE. MRI evaluation of diabetic muscle infarction. Magn Reson Imaging. 1995;13(2):325-9. [Crossref] [PubMed]
- Yagihashi S, Mizukami H, Sugimoto K. Mechanism of diabetic neuropathy: where are we now and where to go? J Diabetes Investig. 2011;2(1):18-32. [Crossref] [PubMed] [PMC]
- Casadei G, Filippini M, Brognara L. Glycated hemoglobin (HbA1c) as a biomarker for diabetic foot peripheral neuropathy. Diseases. 2021;9(1):16. [Crossref] [PubMed] [PMC]
- Rodríguez AJ, Nunes Vdos S, Mastronardi CA, Neeman T, Paz-Filho GJ. Association between circulating adipocytokine concentrations and microvascular complications in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of controlled cross-sectional studies. J Diabetes Complications. 2016;30(2):357-67. [Crossref] [PubMed]
- Jack MM, Ryals JM, Wright DE. Protection from diabetes-induced peripheral sensory neuropathy--a role for elevated glyoxalase I? Exp Neurol. 2012;234(1):62-9. [Crossref] [PubMed] [PMC]
- Lamontagne A, Buchthal F. Electrophysiological studies in diabetic neuropathy. J Neurol Neurosurg Psychiatry. 1970;33(4):442-52. [Crossref] [PubMed] [PMC]
- Ignacio AB, Felix LS, Aguilera-Celorrio Lucianob AC. Diabetes mellitus and neuromuscular blockade: review. J Diabetes Metab. 2016;7:1-4. [Crossref]
- Motamed C, Donati F. Sevoflurane and isoflurane, but not propofol, decrease mivacurium requirements over time. Can J Anaesth. 2002;49(9):907-12. [Crossref] [PubMed]
- Dragne A, Varin F, Plaud B, Donati F. Rocuronium pharmacokinetic-pharmacodynamic relationship under stable propofol or isoflurane anesthesia. Can J Anaesth. 2002;49(4):353-60. [Crossref] [PubMed]
- Agoston S. Interactions of volatile anaesthetics with rocuronium bromide in perspective. Eur J Anaesthesiol Suppl. 1994;9:107-11. [PubMed]
- Pühringer FK, Khuenl-Brady KS, Mitterschiffthaler G. Rocuronium bromide: time-course of action in underweight, normal weight, overweight and obese patients. Eur J Anaesthesiol Suppl. 1995;11:107-10. [PubMed]
- Bevan DR, Fiset P, Balendran P, Law-Min JC, Ratcliffe A, Donati F. Pharmacodynamic behaviour of rocuronium in the elderly. Can J Anaesth. 1993;40(2):127-32. [Crossref] [PubMed]
- de Almeida MC, Latorre F, Gervais HW, Kleeman PP. Die Wirkung des Alters auf Anschlagszeit und Erholung nach Atracurium, Rocuronium und Vecuronium [The effects of age on onset and recovery from atracurium, rocuronium and vecuronium blockade]. Anaesthesist. 1996;45(10):903-6. [Crossref] [PubMed]
- Lee LA, Athanassoglou V, Pandit JJ. Neuromuscular blockade in the elderly patient. J Pain Res. 2016;9:437-44. [Crossref] [PubMed] [PMC]
- Varrique RM, Lauretti GR, Matsumoto JA, Lanchote VL, de Moraes NV. Pharmacokinetics and pharmacodynamics of rocuronium in young adult and elderly patients undergoing elective surgery. J Pharm Pharmacol. 2016;68(11):1351-8. [Crossref] [PubMed]
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