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Selektivt reverseringsmedel för neuromuskulär blockad

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Muskelavslappnande medel

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NMBAs may provide several important benefits:

Reduce patient coughing, moving, and/or bucking.1,2,3

Offer stillness during laparoscopic and/or robot-assisted procedures to reduce interference with surgical field of view.3,4,5

Facilitate surgical exposure and operative manipulations within the abdominal cavity.6,7,8

Assists with low pressure pneumoperitoneum to reduce postoperative shoulder pain following laparoscopic procedures.9

Aid in the manipulation of extremities due to decreased muscular resistance.10

Muscle relaxation during wound closure.11,12

Wound closure with inadequate NMB11

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Wound closure with adequate NMB11

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Deep block has been shown to improve surgical conditions with reduced IAP13

In a clinical study evaluating surgical conditions in laparoscopic colorectal procedures using deep vs moderate rocuroniuminduced NMB, the deep block strategy allowed for appropriate surgical conditions to be maintained with reduced IAPa (mean IAP [mm Hg] was 9.3 with deep NMB vs 12.0 with moderate NMB), resulting in13:

  • Improved surgical conditions, including visual field and muscle relaxationb
  • Significantly lower pain scores in the postanesthesia care unit and at 6, 24, and 48 hoursc
  • Significantly lower IV morphine consumption within 6 to 24 hours after surgeryd
  • Faster bowel movement recoverye

Muscle physiology influences NMB-induced relaxation and stillness15,2

Onset and recovery from a single intubating dose of 0.6 mg/kg rocuronium:
diaphragm and adductor pollicis15

How muscle sensitivity affects surgical conditions2

  • Muscles at the surgical site (eg, diaphragm and abdominal muscles) may require larger doses of NMB to achieve the same level of relaxation as the peripheral muscles (where NMB is typically monitored).
  • Some muscles may experience a faster onset of NMB.
  • Muscles at the surgical site may also recover neuromuscular function faster than peripheral muscles.

Study design

Reproduced with permission from Cantineau JP, Porte F, d’Honneur G, et al. Neuromuscular effects of rocuronium on the diaphragm and adductor pollicis muscles in anesthetized patients. Anesthesiology. 1994;81(3):585–590.1

A clinical study examining the neuromuscular effects of rocuronium on the forces generated by the diaphragm and the adductor pollicis were compared in 18 adult surgical patients ASA Class 1 or 2.1

These forces were in response to stimulation with a current greater than that required to activate all muscle fibers to produce a single twitch. The current was applied to the phrenic and ulnar nerves, which was performed during IV anesthesia in addition to nitrous oxide. The doses for 50% and 95% depression of twitch height were calculated.1

The goal of the first part of the study was to compare the response of the diaphragm with that of the adductor pollicis in 6 patients who received incremental doses of rocuronium up to 0.6 mg/kg over a 9-minute period. In the second part of the study, the goal was to measure the responses of the 2 muscle groups in 12 patients who received a single bolus dose of 0.60 mg/kg of rocuronium using the following parameters: onset times from the end of bolus injection until 50%, 90%, and maximum NMB; the times from injection until recovery of the twitch height to 10%, 25%, 75%, and 90% of control; and the time required for 25%–75% recovery of twitch height.1