Modified rapid sequence induction for Caesarian sections : Case series on the use of rocuronium and sugammadex.
Summary of "Modified rapid sequence induction for Caesarian sections : Case series on the use of rocuronium and sugammadex."
BACKGROUND:
Aspiration is a feared complication of anesthesia and is accompanied by increased morbidity and mortality. Rapid sequence induction (RSI) describes the preferred procedure to perform endotracheal placement of the tubus in emergency cases of patients with an increased risk of aspiration of gastric contents. For more than 50 years RSI has consisted of the application of suxamethonium for neuromuscular blockade because of its fast onset and ultra short duration. Due to the serious side effects of suxamethonium attempts were made to find better alternative neuromuscular blocking drugs, e.g. rocuronium, to perform RSI. MATERIALS AND
METHODS:
In this small clinical series RSI was performed for general anesthesia of ten pregnant women for Caesarean sections using 1.0 mg/kgBW rocuronium for induction and maintaining deep relaxation until the end of surgery. For rapid reversal of the neuromuscular blockade to a train-of-four (TOF) ratio of 0.9, the µ-cyclodextrin sugammadex was administered at the end of surgery. Major and minor side effects, such as cardiac dysrhythmia, anaphylactic reactions, hoarseness and postoperative nausea and vomiting were documented.
CONCLUSIONS:
The combination of rocuronium and sugammadex for RSI combines rapid onset and rapid reversal of neuromuscular blockades with avoidance of serious side effects and very comfortable conditions for intubation in all cases. Minor side effects such as hoarseness, throat discomfort (in up to 30%) and myalgia (10%) for up to 48 h were documented.
Affiliation
Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, Krankenhaus der Barmherzigen Brüder, Nordallee 1, 54290, Trier, Deutschland, dirk.nauheimer@gmx.de.
Journal Details
This article was published in the following journal.
Name: Der Anaesthesist
ISSN: 1432-055X
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22875060
- DOI: http://dx.doi.org/10.1007/s00101-012-2065-6
Medical and Biotech [MESH] Definitions
Anesthetics, Intravenous
Ultrashort-acting anesthetics that are used for induction. Loss of consciousness is rapid and induction is pleasant, but there is no muscle relaxation and reflexes frequently are not reduced adequately. Repeated administration results in accumulation and prolongs the recovery time. Since these agents have little if any analgesic activity, they are seldom used alone except in brief minor procedures. (From AMA Drug Evaluations Annual, 1994, p174)
Frozen Sections
Thinly cut sections of frozen tissue specimens prepared with a cryostat or freezing microtome.
Propanidid
An intravenous anesthetic that has been used for rapid induction of anesthesia and for maintenance of anesthesia of short duration. (From Martindale, The Extra Pharmacopoeia, 30th ed, p918)
Food, Genetically Modified
Food derived from genetically modified organisms (ORGANISMS, GENETICALLY MODIFIED).
Electric Organ
In about 250 species of electric fishes, modified muscle fibers forming disklike multinucleate plates arranged in stacks like batteries in series and embedded in a gelatinous matrix. A large torpedo ray may have half a million plates. Muscles in different parts of the body may be modified, i.e., the trunk and tail in the electric eel, the hyobranchial apparatus in the electric ray, and extrinsic eye muscles in the stargazers. Powerful electric organs emit pulses in brief bursts several times a second. They serve to stun prey and ward off predators. A large torpedo ray can produce of shock of more than 200 volts, capable of stunning a human. (Storer et al., General Zoology, 6th ed, p672)
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