Abstract
BackgroundHyperthermia is relatively rare during general anesthesia; however, a few studies have been conducted on hyperthermia and the neuromuscular blockade (NMB) induced by rocuronium, and the reversal of NMB by sugammadex. We investigated the effect of hyperthermia status on the NMB induced by rocuronium, and its reversal by sugammadex, in isolated phrenic nerve hemidiaphragm (PNHD) preparations of the rat.MethodsThirty-three male Sprague-Dawley rat PNHD preparations were randomly assigned to three groups at different temperatures (36 °C, 38 °C, and 40 °C; each group, n = 11, in Krebs solution). The train-of-four (TOF) and twitch height responses were checked mechanomyographically. The PNHD were treated with progressively increasing doses of rocuronium and three effective concentrations (ECs), EC50, EC90, and EC95, of rocuronium were analyzed in each group via nonlinear regression analysis. Then, sugammadex was administered in doses equimolar to rocuronium. Thereafter, the T1 height (%), TOFR (%) and the duration index were measured.ResultsThe EC of rocuronium (EC50, EC90, and EC95) decreased significantly in accordance with increasing temperature. The groups at 36 °C and 40 °C showed clear differences in all areas (all P < 0.001). Moreover, the T1 height (%) and the duration index upon sugammadex administration showed faster recovery results in the36 °C than the 38 °C and 40 °C groups.ConclusionA rise of temperature from 38 °C to 40 °C in rat PNHD preparations proportionally enhanced the NMB induced by rocuronium. In addition, equimolar doses of sugammadex to the administered rocuronium showed a slower recovery time as the temperature rises.
Highlights
Hyperthermia is relatively rare during general anesthesia; a few studies have been conducted on hyperthermia and the neuromuscular blockade (NMB) induced by rocuronium, and the reversal of NMB by sugammadex
Comparison of the rocuronium concentration responses revealed that the T1 height (%) exhibited a significant decline as the temperature increased in the 36 °C, 38 °C, and 40 °C groups, especially the groups at 36 °C and 40 °C, which showed clear differences in all areas (P = 0.019) (Fig. 1)
Differences existed in effective concentration (EC) between the three groups (Table 2)
Summary
Hyperthermia is relatively rare during general anesthesia; a few studies have been conducted on hyperthermia and the neuromuscular blockade (NMB) induced by rocuronium, and the reversal of NMB by sugammadex. We investigated the effect of hyperthermia status on the NMB induced by rocuronium, and its reversal by sugammadex, in isolated phrenic nerve hemidiaphragm (PNHD) preparations of the rat. Changes in body temperature during an operation result in changes in the pharmacodynamics of drugs such as neuromuscular blocking agents or agents that reverse neuromuscular blockade (NMB) such as sugammadex. We designed specific environmental conditions at hyperthermic temperatures of 38 °C and 40 °C under in vitro conditions to demonstrate the effects of rocuronium and sugammadex using the phrenic nerve hemidiaphragm (PNHD) of rats
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