Effect of body mass index and rocuronium on serum tryptase concentration during volatile general anesthesia: an observational study

OBJECTIVE: Female sex, body mass index (BMI), and neuromuscular blocking agents are risk factors of perioperative hypersensitivity reactions. This study aimed to investigate the effect of rocuronium on serum tryptase concentrations during general anesthesia in overweight and obese women. METHODS: The study was conducted in two groups: Group I (n=66) underwent volatile anesthesia with rocuronium and group II (n=60) underwent volatile anesthesia without any muscle relaxant. Serum tryptase concentration (STC) measurements were performed at baseline (STC 0) and postoperatively (STC 1). ClinicalTrials. gov: NCT04035707 RESULTS: The highest median value of STC 0 was seen in obese patients (3.44 mg L-1) and it was significantly higher than in overweight (p=0.01) and underweight patients (p=0.03). The maximum STC 0 was observed in overweight patients (20.4 mg L-1). In group I, STC 0 in obese patients presented the highest median value (4.49 mg L-1), and was significantly higher than in overweight patients (p=0.03), and had significantly higher STC 1 than patients with normal BMI (p=0.04). STC 0 and STC 1 in overweight and obese female patients did not differ significantly between groups. STC 1 did not correlate with rocuronium doses. In group I, BMI positively correlated with the duration of rocuronium infusion (rho=0.37) and STC 1 positively correlated with BMI (rho=0.32). CONCLUSION: Excess weight and obesity predispose to higher preoperative serum tryptase values. Postoperative STC is not linked to rocuronium doses. BMI is the main determinant factor of STC during combined volatile general anesthesia

Opioid-induced immunosuppression and carcinogenesis promotion theories create the newest trend in acute and chronic pain pharmacotherapy

Opioids are the main group of pharmacological agents used during the perioperative period and provide a sedative and analgesic component. The observations of opioid consumption in West Europe indicate that this group of drugs is widely used in chronic noncancer pain therapy. Nearly 20 years ago, the first publications indicating that opioids, as an element of perioperative pharmacotherapy in oncologic patients, increase the risk of tumor recurrence and affect further prognosis were presented. The actual publications suggest that there are multifactorial, complex mechanisms underlying the immunological impact and carcinogenesis promotion of opioids and that the intensity varies depending on the type of opioid. There are also questions about the immunosuppressive effects among patients receiving opioids in the treatment of chronic noncancer pain. The aim of the review article is to present information about the action of opioids on the immune system in carcinogenic settings and to define the clinical usefulness of this pharmacological phenomenon

Practice Guidelines for Monitoring Neuromuscular Blockade—Elements to Change to Increase the Quality of Anesthesiological Procedures and How to Improve the Acceleromyographic Method

Neuromuscular blocking agents are a crucial pharmacological element of general anesthesia. Decades of observations and scientific studies have resulted in the identification of many risks associated with the uncontrolled use of neuromuscular blocking agents during general anesthesia or an incomplete reversal of neuromuscular blockade in the postoperative period. Residual relaxation and acute postoperative respiratory depression are the most serious consequences. Cyclic recommendations have been developed by anesthesiology societies from many European countries as well as from the United States and New Zealand. The newest recommendations from the American Society of Anesthesiologists and the European Society of Anesthesiology were published in 2023. These publications contain very detailed recommendations for monitoring the dosage of skeletal muscle relaxants in the different stages of anesthesia—induction, maintenance and recovery, and the postoperative period. Additionally, there are recommendations for various special situations (for example, rapid sequence induction) and patient populations (for example, those with organ failure, obesity, etc.). The guidelines also refer to pharmacological drugs for reversing the neuromuscular transmission blockade. Despite the development of several editions of recommendations for monitoring neuromuscular blockade, observational and survey data indicate that their practical implementation is very limited. The aim of this review was to present the professional, technical, and technological factors that limit the implementation of these recommendations in order to improve the implementation of the guidelines and increase the quality of anesthesiological procedures and perioperative safety

Effect of rocuronium on the heart rate and arterial blood pressure during combined general anaesthesia

INTRODUCTION: Additional mechanisms of neuromuscular blocking agents action create the haemodynamic condition during general anaesthesia. The aim was to investigate the effect of rocuronium on haemodynamic parameters during combined general anaesthesia.   MATERIAL AND METHODS: The study was conducted in two groups: Group I underwent combined anaesthesia with rocuronium and Group II — combined anaesthesia without any muscle relaxants. Haemodynamic parameters: heart rate, systolic, diastolic and mean arterial blood pressure were recorded before anaesthesia, at the end of rocuronium infusion, and after recovery from anaesthesia.   RESULTS: In both groups, the values of the median heart rate, systolic, diastolic and mean arterial blood pressure recorded before and after anaesthesia were similar and did not differ significantly. In Group I, significant reduction in heart rate in the end of rocuronium infusion [74 (61–103)], (p = 0.01) and after recovery from anesthesia [71 (53–100)], (p = 0.03), compared to the value before anesthesia [81 (56–104)], were demonstrated. Additionally, significant reduction in systolic [130 (96–169); 114 (92–144)], (p = 0.04), diastolic [80 (54–109); 73 (47–99)], (p = 0.01), and mean [95 (72–106); 85 (68–109)], (p = 0.02) arterial blood pressure in the end of rocuronium infusion were noticed. The values of systolic, diastolic and mean blood pressure after recovery from anaesthesia significantly increased in relation to the values observed in the end of the rocuronium infusion [129 (96–181)], (p = 0.01); [78 (47–107)], (p = 0.03); [93 (63–107)], (p = 0.03).   CONCLUSIONS: The vagolytic effect was not observed during general anaesthesia with rocuronium. The changes in heart rate and blood pressure were associated with the rocuronium infusion and were normalized after recovery from anaesthesia