Effect Of Ropivacaine Combined With Pancuronium On Neuromuscular Transmission And Effectiveness Of Neostigmine And 4-aminopyridine For Blockade Reversal: Experimental Study [efeito Da Associação Ropivacaina-pancurÔnio Na Transmissão Neuromuscular E Eficácia Da Neostigmine E 4-aminopiridina Na Reversão Do Bloqueio: Estudo Experimental]

Background and objectives: The local anesthetic effects on neuromuscular junction and its influence on blockade produced by nondepolarizing neuromuscular blockers are still under-investigated; however, this interaction has been described in experimental studies and in humans. The aim of this study was to evaluate in vitro the interaction between ropivacaine and pancuronium, the influence on transmission and neuromuscular blockade, and the effectiveness of neostigmine and 4-aminopyridine to reverse the blockade. Methods: Rats were divided into groups (n=5) according to the study drug: ropivacaine (5μgmL-1); pancuronium (2μg.mL-1); ropivacaine+pancuronium. Neostigmine and 4-aminopyridine were used at concentrations of 2μgmL-1 and 20μgmL-1, respectively. The effects of ropivacaine on membrane potential and miniature end-plate potential, the amplitude of diaphragm responses before and 60minutes after the addition of ropivacaine (degree of neuromuscular blockade with pancuronium and with the association of pancuronium-ropivacaine), and the effectiveness of neostigmine and 4-aminopyridine on neuromuscular block reversal were evaluated. Results: Ropivacaine did not alter the amplitude of muscle response (the membrane potential), but decreased the frequency and amplitude of the miniature end-plate potential. Pancuronium blockade was potentiated by ropivacaine, and partially and fully reversed by neostigmine and 4-aminopyridine, respectively. Conclusions: Ropivacaine increased the neuromuscular block produced by pancuronium. 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Use Of Protocol And Evaluation Of Postoperative Residual Curarization Incidence In The Absence Of Intraoperative Acceleromyography - Randomized Clinical Trial

Objective: Evaluate the incidence of PORC in the post-anesthesia care unit (PACU) after the use of protocol and absence of intraoperative acceleromyography (AMG). Methods: Randomized clinical trial with 122 patients divided into two groups (protocol and control). Protocol group received initial and additional doses of rocuronium (0.6. mg/kg and 10. mg, respectively); the use of rocuronium was avoided in the final 45. minutes; blockade reversal with neostigmine (50. μg/kg); time ≥ 15. minutes between reversion and extubation. Control: initial and additional doses of rocuronium, blockade reversal, neostigmine dose, and extubation time, all at the discretion of the anesthetist. AMG was used in the PACU and PORC considered at T4/T1 ratio. <. 1.0. Results: The incidence of PORC was lower in protocol group than in control group (25% vs. 45.2%, p = 0.02). In control group, total dose of rocuronium was higher in patients with PORC than without PORC (0.43 vs. 0.35. mg/kg/h, p = 0.03) and the time interval between the last administration of rocuronium and neostigmine was lower (75.0 vs. 101.0. min, p <. 0.01). In protocol group, there was no difference regarding the analyzed parameters (with PORC vs. without PORC). Considering the entire study population and the presence or absence of PORC, total dose of rocuronium was higher in patients with PORC (0.42 vs. 0.31. mg/kg/h, p = 0.01), while the time interval between the last administration of rocuronium and neostigmine was lower (72.5 vs. 99.0. min, p ≤ 0.01). Conclusion: The proposed systematization reduced PORC incidence in PACU in the absence of intraoperative AMG. © 2017