Loading...
6 results
Search Results
Now showing 1 - 6 of 6
- Comparison of two pharmacokinetic–pharmacodynamic models of rocuronium bromide during profound neuromuscular block: analysis of estimated and measured post-tetanic count effectPublication . Couto, Mafalda; Vide, Sérgio; Marco-Ariño, Nicolás; Troconiz, Iñaki F.; Esteves, Simão; Nunes, Catarina S.; Amorim, Pedro; Mendes, JoaquimBackground: Profound neuromuscular block (NMB) is important in surgeries where complete immobility is considered essential to improve tracheal intubation and surgical conditions. Rocuronium bromide is a commonly used NMB agent. This work describes a noninvasive approach for estimation of post-tetanic count (PTC) based on two pharmacokinetic (PK) models, the Saldien and the De Haes models. The aim was to investigate the rocuronium bromide PKepharmacodynamic (PD) relationship in estimating the PTC effect during profound NMB. Methods: In this prospective, non-randomised, observational study, an induction bolus of rocuronium bromide was administered followed by continuous infusion for maintenance of a PTC of 1-2. measured every 3 min. Measurements were analysed as discrete categorical data and by applying the nonlinear mixed-effect modelling approach. Performance of the selected models was evaluated through simulation model-based diagnostics, further assessing the precision of the parameter estimates and the performance of the models at the individual level. Results: Data from 30 adult patients undergoing elective abdominal or neurosurgical procedures were included. Posttetanic count response profiles during rocuronium bromide infusion were successfully characterised using the population PD analysis. The models showed a good performance for all PTC categories, albeit with a moderate over-prediction of PTC >6. Conclusions: Our findings indicate that using plasma concentrations of rocuronium bromide estimated with either of the two models, combined with a PD model, provides equal model performance when predicting PTC. These promising results may provide an important advance in guiding rocuronium bromide administration when profound NMB in routine clinical practice is desired.
- Incidence of postoperative residual neuromuscular blockade: a multicenter, observational study in Portugal (INSPIRE 2)Publication . Esteves, Simão; Barros, Filinto Correia de; Nunes, Catarina S.; Puga, Andreia; Gomes, Blandina; Abelha, Fernando; Machado, Humberto; Ferreira, Milene; Fernandes, Nuno; Vítor, Paula; Pereira, Sandra; Lapa, Teresa A.; Oliveira, Vítor PinhoBackground: Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess RNMB incidence and management in Portugal. Methods: Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals. The primary endpoint was the proportion of patients arriving at postanesthesia care unit (PACU) with a TOF ratio ,0.9. Results: A total of 366 patients were included, with a median age of 59 years, and 89.1% classified as ASA II or III. Rocuronium was the most used NMBA (99.5%). A total of 96.2% of patients received a reversal agent, 96.6% of which sugammadex and 3.4% neostigmine. Twenty patients displayed a TOF ratio ,0.9 at PACU arrival, representing an RNMB incidence of 5.5% (95% CI, 3.1%–7.8%). Only two patients displayed a TOF ratio ,0.7. RNMB incidence was 16.7% with neostigmine and 5.3% with sugammadex (P 5 .114). In patients with intraoperative neuromuscular blockade (NMB) monitoring, RNMB incidence was 5% (95% CI, 2%–8%), which varied significantly according to the type of monitoring (P 5 .018). Incidence of adverse events was 3.3% (2 severe and 10 moderate). Conclusions: The reported overall incidence of 5.5% is numerically lower than results from similar observational studies. An appropriate pharmacological neuromuscular reversal strategy, guided by quantitative neuromuscular monitoring, has the potential to achieve even better results, converting RNMB from an unusual to a very rare or even inexistent event.
- Deep neuromuscular blockade with sugammadex reversal for cervical spine surgery may not be less costly than standard clinical practice of rocuronium bolus and neostigmine reversalPublication . Amorim, Pedro; Nunes, Catarina S.; Casal, Manuela; Correia, Leónia; Machado, Humberto; Esteves, Simão
- Deep neuromuscular blockade with sugammadex reversal, reduced both anesthetic requirements and recovery times in cervical spine surgery patients: a randomized controlled trialPublication . Amorim, Pedro; Nunes, Catarina S.; Casal, Manuela; Correia, Leónia; Machado, Humberto; Esteves, Simão
- Incidence of postoperative residual neuromuscular blockade: a multicenter, observational study in Portugal (INSPIRE 2)Publication . Esteves, Simão; Barros, Filinto Correia de; Nunes, Catarina S.
- Incidência do bloqueio neuromuscular residual no pós-operatório: estudo observacional multicêntrico em Portugal (Inspire 2)Publication . Esteves, Simão; Correia de Barros, Filinto; Nunes, Catarina S.