Adamgammadex in patients to reverse a moderate rocuronium-induced neuromuscular block.

AIMS: The aim of this study was to investigate the effectiveness, safety and pharmacokinetics of adamgammadex in surgical patients. METHODS: Forty-eight patients aged 18-64 years old were randomized to receive adamgammadex (2, 4, 6, and 8 mg.kg-1 ) or placebo at a ratio of 10:2 for reversal of 0.6 mg.kg-1 rocuronium-induced neuromuscular block. Neuromuscular function was monitored by TOF-Watch® SX. When the T2 of train-of-four (TOF) reappeared at the end of surgery, patients received an intravenous administration of adamgammadex or placebo. RESULTS: The recovery time of the TOF ratio to 0.9 decreased significantly from 39.3 [29.5, 50.2] minutes in the group that received placebo to 3.0 [2.3, 3.9] minutes, P < .0001; 2.1 [1.5, 3.0] minutes, P < .0001; 2.1 [1.8, 3.3] minutes, P < .0001; and 1.8 [1.5, 2.2] minutes, P < .0001 in the 2, 4, 6 and 8 mg.kg-1 adamgammadex groups, respectively. Then, adamgammadex also showed a shortened recovery time for the TOF ratio recovered to 0.8 and 0.7. Adamgammadex was well tolerated, and no cases of anaphylactic reactions, post-operative bleeding, recurarization, abnormal basic vital signs and prolonged QT intervals were observed. The pharmacokinetics of adamgammadex in plasma increased in dose-dependent manner. The 24-hour cumulative fraction of adamgammadex in urine was 65-83%, and that of rocuronium was increased after using adamgammadex from 15% to about 25-30%. CONCLUSION: Adamgammadex was found to be effective for reversal of rocuronium-induced neuromuscular block, and it was safe and well tolerated in patients.

[Effect of optimizing anesthetic injecting sequence during induction on fentanyl-induced coughing].

OBJECTIVE: To observe the effect of optimizing anesthetic injecting sequence during induction on fentanyl-induced coughing. METHODS: One hundred and twenty ASA I or II elective patients undergoing general anesthesia were randomly allocated to optimized group or control group: the optimized group induced with midazolam 0.06 mg/kg, followed by fentanyl 1 mg/kg at 1 min later, vecuronium 0.1 mg/kg at 1 min 55 s, propofol 1.5-2 mg/kg at 2 min, a second dose of 3 mg/kg fentanyl at 2 min 20 s, intubated at time 5 min; the control group was induced with the same medication but all the fentanyl (4 mg/kg) was injected at time 1 min. Coughing after fentanyl injection was observed and hemodynamic parameters were recorded. RESULTS: Hemodynamic changes were identical between the two groups indicated similar intubation response suppression. The incidence of fentanyl-induced coughing was significantly lower in the optimized group (4/60) than in the control group (23/60) (P < 0.01). CONCLUSION: Optimizing anesthetic injecting sequence during induction by separate fentanyl into two boluses significantly reduce fentanyl-induced coughing without affecting intubation response suppression.

[Effect of long-term sevoflurane anesthesia on markers of myocardial damage].

OBJECTIVE: To investigate the effect of long-term sevoflurane anesthesia on markers of myocardial damage or toxicity. METHODS: Forty adult patients scheduled for upper abdominal surgery with general anesthesia for 4 hours or more were randomly divided into Group S and PR (n=20 each). After anesthesia induction, patients of Group S were maintained with only sevoflurane, and patients of Group PR with target-controlled infusion of propofol 2-4 microg/ml and remifentanil 4-8 ng/ml. Anesthesia was titrated to control blood pressure and heart rate change at less than 20 percent of baseline values. Blood samples were draw at pre-induction, 4 h and 24 h post-induction respectively. Serum level of cardiac troponin I, creatine kinase MB and myoglobin were analyzed. RESULTS: There were no significant changes of troponin I, creatine kinase MB and myoglobin in Group S between pre-induction and 4 h or 24 h post-induction (P > 0.05). And there was also no significant differences as compared with Group PR (P > 0.05). CONCLUSION: At the concentration range of 1.6%-3%, long-term sevoflurane anesthesia does not cause detectable changes of markers of myocardial damage or toxicity.

[Protective effects of hydroxyethyl starch (130/0.4) against ischemia reperfusion injury of kidney: experiment with rats].

OBJECTIVE: To explore the protective effects of hydroxyethyl starch (HES)(130/0.4) against ischemia reperfusion injury of kidney and its impact on the expression of intercellular adhesion molecule-1 (ICAM-1). METHODS: Forty SD rats underwent resection of the right kidney and clamping of the left renal artery for 60 min to establish renal ischemia reperfusion model, and then were randomly divided into 4 equal groups: Group S, undergoing infusion of normal saline 20 mg/kg 20 min before the reopening of the renal artery, Group W1, undergoing infusion of HES 5 mg/kg 20 min before the reopening of the renal artery, Group W2, undergoing infusion of HES 10 mg/kg, and Group W3, undergoing infusion of normal saline 20 mg/kg. Ten rats underwent sham operation and were used as controls (Group C). 24 h after reperfusion arterial blood samples were collected to detect 6 the levels of serum creatinine (Cr) and blood urea nitrogen (BUN), and then the rats were killed with their kidneys taken out to undergo pathological examination and calculation of Paller's score. Immunohistochemistry was used to detect the expression of intercellular adhesion molecule-1 (ICAM-1). RESULTS: The levels of BUN and Cr of Group S were 152 +/- 22 and 3.17 +/- 1.00 mmol/L respectively, both significantly higher than those of Group C, and the levels of BUN and Cr of Groups W2 and W3 were 99 +/- 23 and 1.82 +/- 0.86 mmol/L and 92 +/- 28 and 1.57 +/- 0.70 mmol/L respectively, all significantly lower than those of Group S (P < 0. 05 or P < 0.01). The Paller's scores of W2 and W3 were 33.6 +/- 16.6 and 29.2 +/- 12.3 respectively,both significantly lower that of Group S (43.2 +/- 15. 8, both P < 0.05). The absorption levels of ICAM-1 of Groups W2 and W3 were 182 +/- 22 and 161 +/- 25 respectively, both significantly lower than that of Group S (212 +/- 32, P < 0.01). CONCLUSION: Infusion of 10-20 ml/kg HES (130/0.4) significantly alleviates the ischemia-reperfusion injury, probably by reducing the ICAM-1 expression.

[Comments on anesthesia machines' and monitors' designs].

From a view point of an anesthesiologist, the article points out some design issues of modern monitors and anesthesia machines. User interface problems such as auto-adjusted amplitude display, excessively complicated menus, unreasonable switch arrangement, unsuitable alarm settings or identical cylinder connectors, may affect patient safety and increase anesthesiologists' workload or mental burden.