Abstract
Objective: Recovery from neuromuscular blockade could be delayed and the risk of postoperative residual neuromuscular blockade (RNMB) could be an important anesthetic consideration in diabetic patients undergoing general anesthesia due to decreased nerve conduction velocity. The aim of this study was to analyse the recovery from rocuronium and the risk of postoperative RNMB in type-II diabetic patients undergoing general anesthesia with sevoflurane.
 
 Materials and Methods: The patients undergoing general anesthesia with sevoflurane and rocuronium for abdominal surgery were included in this prospective observational study between December 2014 - May 2015. After rocuronium injection; time to reappearance of T1, T2, T3 and T4 and time to reaching TOF ratios of 0.7 and 0.9 were recorded. For detecting RNMB, TOF ratios were recorded in the postoperative care unit at 5th and 10th minutes of arrival. The correlation between glycemic control and the risk of RNMB was also evaluated via glycosylated haemoglobin (HbA1c) levels.
 
 Results: A total of 82 patients (Group DM: 48 patients, Group non-DM: 34 patients) were included. The groups were comparable according to demographic data and other characteristics that can effect neuromuscular blockade. Times to reappearance of T1, T2, T3, T4 and to reaching a TOF ratio of 0.9 were significantly longer in Group DM. Although there was no difference between the TOF ratios at the arrival to the postoperative care unit, TOF ratios of Group DM were significantly lower at 5th and 10th minutes at postoperative care unit. Poor glycaemic control was found not to affect the risk of RNMB.
 
 Conclusion: Even in the absence of known neurologic complications; the neuromuscular blockade effect of rocuronium is longer and the risk of RNMB is higher in type-II diabetic patients irrespective of the degree of glycaemic control.
 
 Keywords: Diabetes Mellitus, Rocuronium, Residual Neuromuscular Blockade
Highlights
Diabetes mellitus (DM) can lead to decreased nerve conduction velocity as a result of segmental demyelination and partial degeneration of nerve fibers and loss of motor units [1]
All patients were extubated when train of four (TOF) ratio became 0.9 and transferred to post-anesthesia care unit (PACU) but there was a significant decrease in TOF ratios measured at 5th and 10th minutes at PACU in Group DM compared to Group NDM
This study revealed that times to reappearance of T1, T2, T3, T4 and to reaching a TOF ratio of 0.9 were significantly longer in diabetic patients compared to the control group
Summary
Diabetes mellitus (DM) can lead to decreased nerve conduction velocity as a result of segmental demyelination and partial degeneration of nerve fibers and loss of motor units [1]. In vitro studies have shown that DM affects both metabolic and transmission functions at the neuromuscular junction due to impaired glucose transport and secretion of acetylcholine from the presynaptic motor nerve endings [2]. Skeletal muscle damages such as muscular infarction and atrophy have been reported in diabetic patients [3,4]. Nitahara et al showed that neuromuscular function recovery following vecuronium is prolonged in diabetic patients compared to non-diabetics, even in the absence of diabetic neuropathy or nephropathy [5]. The studies conducted with rocuronium, which has a more rapid onset of action and recovery profile, reveal controversial results.
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