Residual neuromuscular block in type II diabetes mellitus after rocuronium: a prospective observational study.

BACKGROUND: Diabetes mellitus causes motor nerve dysfunction and degeneration that may alter the response to neuromuscular blocking drugs. OBJECTIVE: To analyse the risk of residual neuromuscular block (RNMB) induced by rocuronium given in standard doses to patients with type 2 diabetes mellitus (T2DM). DESIGN: A prospective, observational study. SETTINGS: Hospital San Jorge, Huesca and Hospital San Pedro, Logroño, Spain, from December 2011 to June 2012. PATIENTS: T2DM patients with no diabetic neuropathy or neurological symptoms (n = 32) and healthy controls (n = 39). INTERVENTION: All participants received a single dose of rocuronium 0.6 mg kg. Neuromuscular block was monitored throughout surgery until a train of four (TOF) ratio of at least 0.9 was achieved. MAIN OUTCOME: Time from rocuronium injection to a TOF ratio of at least 0.9 (DURTOF90). SECONDARY OUTCOMES: Time to reappearance of T1, T2, T3 and T4 of TOF; glycosylated haemoglobin values (HbA1c); correlation between blood glucose control and DURTOF90 in the group of diabetic patients. RESULTS: No significant differences in age, weight, renal function or other characteristics interfering with neuromuscular block were seen between T2DM patients and controls. DURTOF90 was significantly longer in the group of T2DM patients than in the controls (109.86 vs. 84.77 min, P = 0.001). Times to reappearance of T1, T2, T3 and T4 of TOF were also significantly longer in the T2DM group. No correlation was found between HbA1C and DURTOF90 values. In addition, DURTOF90 did not appear to be related to elevated blood glucose levels. CONCLUSION: Diabetic patients, even in the absence of complications, have an increased risk of RNMB after rocuronium administration compared with those without diabetes. Poorer glycaemic control of diabetes does not appear to increase the risk. Appropriate dose and vigilant monitoring of the neuromuscular blocker is helpful in patients with T2DM.

Sevoflorano como coadyuvante en la sedación durante ventilación mecánica en pacientes médicos de Unidad de Cuidados Intensivos: resultados preliminares en una serie de casos / Sevoflorane as adjuvant for sedation during mechanical ventilation in intensive care unit medical patients: Preliminary results of a series of cases

Objective: To disclose our preliminary experience in inhalation sedation with sevoflorane in a standardized manner using the Anesthetic Conserving Device in intubated, critically ill patients in our ICU. Patients: It has been used in nine cases of adult patients, six men and three women, over 24 months. Results: A proper implementation of the protocol by physicians and the nursing staff has been achieved, meeting the goals established for sedation (RASS 0, -2) free of hepatic or renal adverse outcomes or side effects. Conclusions: In our limited experience, adjuvant inhalation sedation with sevoflorane in the ICU is safe and complementary to the use of intravenous drugs such as propofol, remifentanil and midazolam, which are currently commonly used to achieve goal-directed sedation.

Objetivo: Explicar nuestra experiencia preliminar en la utilización de sedación inhalatoria de manera estandarizada con sevoflorano mediante dispositivo Anesthetic Conserving Device en pacientes críticos intubados en nuestra UCI. Pacientes: se ha utilizado en 9 casos, en pacientes adultos, 6 hombres y 3 mujeres, durante un periodo de 24 meses. Resultados: se ha conseguido una adecuada implantación del protocolo por parte de médicos y personal de enfermería, logrando los objetivos de sedación fijados en un primer momento (RASS 0, -2) y sin obtener resultados adversos ni efectos secundarios a nivel hepático y/o renal. Conclusiones: en nuestra limitada experiencia, la sedación inhalatoria con sevoflorano coadyuvante en UCI es una técnica segura y complementaria al uso de fármacos intravenosos, como propofol, remifentanilo y midazolam, utilizados habitualmente, para lograr una sedación guiada por objetivos.