medigraphic.com
Órgano Oficial del Hospital Angeles Health System

2019, Number 1

<< Back Next >>

Acta Med 2019; 17 (1)

Effect of dexamethasone on the duration of the neuromuscular blockade produced by rocuronium

Vara FA, Elizalde FF, Delgado CMM, Pinto SME, López GM

Language: Spanish
References: 16
Page: 7-14
PDF size: 214.56 Kb.


ABSTRACT

A glucocorticoid monodose improves the patient’s evolution under anesthesia, but the prolonged administration decreases the duration of the neuromuscular block. Objective: To determine the effect of a dexamethasone monodose on the duration of the neuromuscular blockade induced with rocuronium. Material and methods: Observational, randomized, longitudinal and prospective study. Patients who received a dexamethasone monodose (200 µg/kg) one hour prior to surgery (group A), in the anesthetic induction (group B) and in the recovery from the neuromuscular block (group C). The degree of neuromuscular block was evaluated with the a TOF-Watch ®SX monitor. The neuromuscular transmission was measured at its basal state and after administering rocuronium, starting at minute zero, the maximum depression of the simple stimulus, the onset of action, the clinical duration, the recovery index, the train of four, the postetanic score and the recovery index ≥ 0.9 for extubation. Results: 12 patients were assigned per group. Group A had a greater decrease in the duration of the neuromuscular block compared to B and C (recovery index ≥ 0.9 min): group A: 42.6 ± 9.1, B: 49.6 ± 0.4, C: 55 ± 16.2); p ‹ 0.05 group A versus B. p ‹ 0.05 group A versus C. Conclusion: A dexamethasone monodose decreases the duration of the neuromuscular block by rocuronium in 10-20%.


REFERENCES

  1. De Oliveira GS, Santana LJ, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg. 2013; 116 (1): 58-74.

  2. Malgor L, Valsecia M. Farmacología de los glucocorticoides suprarrenales. En: Mendoza PN. Farmacología médica. 2.a ed. Ed. Facultad de Medicina, Universidad Nacional del Nordeste; 2008. pp. 147-163.

  3. De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain. A meta-analysis of randomized controlled trials. Anesthesiology. 2011; 115 (3): 575-588.

  4. Serra HA, Roganovich JM, Rizzo L. Glucocorticoides: paradigma de medicina traslacional de lo molecular al uso clínico. Medicina (Buenos Aires). 2012; 72 (2): 158-170.

  5. Bowman WC. Neuromuscular block. Br J Pharmacol. 2006; 147 (Suppl 1): S277-S286.

  6. Fagerlund MJ, Eriksson LI. Current concepts in neuromuscular transmission. Br J Anaesth. 2009; 103 (1): 108-114.

  7. Pinzón PA, Torres JV, Reyes LE. Recomendaciones para el manejo de bloqueadores neuromusculares en la práctica clínica: análisis de un grupo de estudio en bloqueadores neuromusculares. Rev Mex Anest. 2010; 33 (2): 88-96.

  8. Naguib M, Lien CA. Farmacología de los relajantes musculares y sus antagonistas. En: Miller RD, Eriksson LI, Fleisher LA, Kronish JP, Young WL. Miller anestesia. Vol. 1. Séptima edición. España: Editorial Elsevier; 2010. pp. 625-653.

  9. Mirakhur RK. Newer neuromuscular blocking drugs. An overview of their clinical pharmacology and therapeutic use. Drugs. 1992; 44 (2): 182-199.

  10. Chamorro C, Romera MA, Pardo C, Silva JA. New neuromuscular blockers. Medicina Intensiva. 2001; 25 (9): 340-343.

  11. Fabregat J, Candia CA, Castillo CG. La monitorización neuromuscular y su importancia en el uso de los bloqueantes neuromusculares. Revista Colombiana de Anestesiología. 2012; 40 (4): 293-303.

  12. McGrath CD, Hunter JM. Monitoring of neuromuscular block. Continuing education in anaesthesia. Critical Care Pain. 2006; 6 (1): 7-11.

  13. Viby-Mogensen J, Jensen E, Werner M, Kirkegaard Neilsen H. Measurement of acceleration a new method of monitoring neuromuscular function. Acta Anaesthesiol Scand. 1988; 32 (1): 45-48.

  14. Soltesz S, Stark C, Noé KG, Anapolski M, Mencke T. Monitoring recovery from rocuronium-induced neuromuscular block using acceleromyography at the trapezius versus the Adductor pollicis muscle: an observational trial. Can J Anesth. 2016; 63 (6): 709-717.

  15. Fuchs T, Claudius C, Skovgaarg L, Eriksson L, Mirakhur R, Mogensen J. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007; 51 (7): 789-808.

  16. Soltész S, Mencke T, Stunz M, Diefenbach C, Ziegeler S, Molter GP. Attenuation of a rocuronium induced neuromuscular block in patients receiving prednisolone. Acta Anaesthesiol Scand. 2009; 53 (4): 443-448.




2020     |     www.medigraphic.com