Low-dose Rocuronium Research Articles

Comparison between conventional-dose and high-dose rocuronium use in general anesthesia for Cesarean section.

Background: There have been few studies comparing the effects of high- and low-dose rocuronium during cesarean section by directly measuring the concentration. Therefore, we conducted a study to examine the blood concentrations and clinical effects of both doses of rocuronium on mothers and fetuses. Methods: Eighteen patients were randomly assigned to two groups: C Group (0.6 mg/kg), and H Group, (1.0 mg/kg). The primary outcome was the comparison of umbilical vein rocuronium concentration between two groups. We assessed ease of intubation, time from rocuronium administration to some TOF points, post-anesthesia care unit (PACU) stay time, infused remifentanil dose, maternal rocuronium concentration, and Apgar scores. Results: No differences were observed in demographic data, ease of intubation, PACU stay time, 1 min Apgar scores, umbilical venous blood gas analysis between both groups. However, the time from rocuronium administration to T3 disappearance was shorter (p=0.009) and time to T1 and T2 reappearance were longer (p=0.003, p=0.009) in H group than that in C group. The administered remifentanil dose (p=0.042) was lower in the H group than in the C group. Rocuronium concentrations in the umbilical vein (p=0.004) and maternal vein before cord clamping (p=0.002) and at discharge (p<0.001) were also found to be higher in the H group than in the C group. Conclusions: We observed no prolongation of PACU stay, and no differences in Apgar scores in H group compared to C group. It suggests that 1.0 mg/kg of rocuronium has no negative effects on the fetus and mother in cesarean section.

The optimal induction dose of ciprofol combined with low-dose rocuronium in children undergoing daytime adenotonsillectomy

Adenotonsillectomy is the most common daytime surgery performed on children. Anesthesiologists must select the optimal combination of drugs to ensure effective anesthesia effect and prompt recovery in children. The optimal induction dose of ciprofol in children is unclear. In this study, we aim to investigate the effect of different doses of ciprofol on anesthesia induction in children undergoing daytime adenotonsillectomy and provide a reference for clinical use. 144 children aged 3–12 years, ASA I-II, undergoing daytime adenotonsillectomy, were included in this clinical trial. The children were randomly divided into three groups and given 0.4 mg/kg (C4), 0.6 mg/kg (C6), or 0.8 mg/kg (C8) of ciprofol for anesthesia induction. The primary outcome was intubation conditions. Vital signs and injection pain were also recorded. The rates of unacceptable intubation conditions were 30.6%, 8.7%, and 8.2% in the C4, C6, and C8 groups (P value < 0.0167). The overall incidence of reported injection pain was 3.5%. The heart rate and mean arterial pressure did not differ between the groups at the same time points. We found that combining 0.6 mg/kg of ciprofol with low-dose rocuronium could provide optimal intubation conditions in pediatric daytime adenotonsillectomy patients. This combination resulted in stable circulation and BIS values. This study is registered at the Chinese Clinical Trial Registry (Registration number: ChiCTR2200063144, Date of Registration: 31/08/2022)

Assessing First Pass Success Rate with Low Dose Rocuronium during Rapid Sequence Intubation among Patients in an Emergency Department

Assessing First Pass Success Rate with Low Dose Rocuronium during Rapid Sequence Intubation among Patients in an Emergency Department

Comparison between use of fentanyl and rocuronium on outpatient undergoing ultra-short duration gynecologic surgery: a randomized, double-blind, controlled trial

Background: There has been a steady increase in outpatient-based ultra-short duration gynecology surgeries. However, there are no detailed studies on anesthesia regimens for these surgeries. The aim of this study was to compare the effects of low-dose rocuronium and fentanyl single bolus for their suitability with these patients. Methods: A total of 60 patients were randomly divided into three groups: a control group (group C, n = 20) that received 3 mL of normal saline; a fentanyl group (group F, n = 19) that received 1 mcg/kg of fentanyl; and a low-dose rocuronium group (group R, n = 20) that received 0.3 mg/kg of rocuronium. We collected hemodynamic data during anesthetic induction and the intraoperative period. We also investigated supraglottic airway (SGA) insertion condition, patient’s gross movements, and surgeon’s satisfaction. In addition, we evaluated the incidence of postoperative nausea and vomiting, pruritus, first voiding time and discharge time from the postanesthetic care unit. Results: Systolic, diastolic, and mean blood pressure were significantly lower in group F after SGA insertion (p = 0.031, p = 0.046 and p = 0.048). SGA insertion conditions scores were significantly worse in group C than in group F and group R for total score (p &lt; 0.001). Also, the number of patient movements during surgery and the number of rescue fentanyl injections were significantly higher in group C than group F and group R (p = 0.005 and p &lt; 0.001). Conclusion: Fentanyl administration at 1 mcg/kg has advantages compared with rocuronium and is a more suitable single agent regimen for outpatient-based ultra-short duration gynecology surgeries.

The effect of adding magnesium sulfate to low dose rocuronium on neuromuscular blockade and anesthesia for direct laryngoscopy: A randomized controlled trial

The effect of adding magnesium sulfate to low dose rocuronium on neuromuscular blockade and anesthesia for direct laryngoscopy: A randomized controlled trial

Low-Dose of Rocuronium During Thyroid Surgery: Effects on Intraoperative Nerve-Monitoring and Intubation

BackgroundIntraoperative Neurophysiological Monitoring (IONM) reduces the incidence of Recurrent Laryngeal Nerve (RLN) injuries during thyroid surgery. To preserve nerve function, long acting neuromuscular blocking agents (NMBA) should be avoided. However, NMBA are necessary for laryngoscopy and endotracheal intubation. We designed this double-blinded, randomized, placebo-controlled trial to assess if a low-dose of rocuronium given at intubation would affect the IONM data recorded before the thyroid dissection. MethodsHundred patients undergoing elective thyroid surgery were randomized to receive either 0.3 mg kg−1 of low dose rocuronium (intervention) or no-NMBA (control). Intubation was performed with video-laryngoscopy. IONM was placed on RLN and nerve stimulation was performed before and after thyroid dissection. The presence of a valid amplitude prior to dissection was defined when the IONM signal was >100 μV. Occurrence of difficult laryngoscopy was reported together with intubation details including time, difficulty and failure. The lowest peripheral saturation (SpO2) and the number of desaturation episodes during the intubation were also registered. ResultsNo patients showed impaired IONM signal before dissection in both groups. Cormack-Lehane grade was higher in the intervention group (11;2) compared to control one (11;1; P = 0.046). No-NMBA patients had increased number of difficult laryngoscopies (21% versus 6%, P = 0.041) and intubations (34% versus 8%; P = 0.003) as well as a longer time to intubation (78 [55; 175] versus 55 [31; 110] sec; P = 0.006). Lower values of peripheral SpO2 during intubation attempt were registered in the no NMBA group (99 [97; 100] versus 99 [99; 100] %; P = 0.020). However, the number of intubation failure was similar between groups (p=0.495). ConclusionsLow-dose of rocuronium does not compromise pre-dissection IONM signal and improves intubation condition when compared to a relaxant free strategy.

Low-dose Rocuronium Effect Neural Monitoring in Thyroid Surgery

Low-dose Rocuronium Effect Neural Monitoring in Thyroid Surgery

Comparison of effect of anticholinergic premedication on intubation condition and time on induction with low dose rocuronium in children undergoing short surgical procedures

Comparison of effect of anticholinergic premedication on intubation condition and time on induction with low dose rocuronium in children undergoing short surgical procedures

To compare the effect of Low Dose Atracurium versus Low Dose Rocuronium on quality of intubation in children undergoing adenotonsillectomies.

Objectives: We conducted this study by comparing low dose of atracurium with low dose rocuronium to see their effects on quality of endotracheal intubation and recovery characteristics as these both agents are widely available and practiced in anesthesia. Study Design: This is prospective, randomised, double blind clinical trial. Setting: ENT operating room of King Khalid Hospital, Saudi Arabia. Period: From January 2018 to April 2018. Material &amp; Methods: In this study, 80 elective paediatric patients planned for adenotonsillectomies operations were randomly selected. Anesthesia was induced by using fentanyl 2 mcg/kg, propofol 2 mg/kg. Patients were divided into two groups, group A and group R. Group A received 0.3 mg/kg atracurium and group R received 0.3 mg/kg rocuronium to facilitate endotracheal intubation. Sevoflurane was used for maintenance of anaesthesia in 50 percent oxygen and 50 percent nitrous oxide. Dexamethasone 0.1 mg/kg was administered in all patients to reduce post operative airway oedema and prophylaxis for PONV. Quality of intubation was assessed and graded as; Good: Jaw and vocal cords relaxed and no patient movement/coughing upon laryngoscopy/intubation. HR and BP within 20 percent range. Fair: Jaw and vocal cords relaxed but patient show body movement/coughing upon laryngoscopy/intubation HR and BP within 20 percent range. Poor: Jaw is partially relaxed, vocal cords moving/closed and patient shows body movement/coughing upon laryngoscopy/intubation. HR and BP beyond 20 percent range. Results: There were 40 patients in each group. 37.5 percent were operated for tonsillectomy, 32.6 percent for adenotonsillectomy and 30.1 percent for tonsillectomy and there was no statistically significant difference regarding type of operation (P=0.861). Age (P=0.321), sex (P=0.370) and weight (P=0.243) in both groups. Grades of intubation quality were comparable and same in both groups (P=0.710). Extubation and recovery was also normal and same in both groups. Conclusion: Low doses of atracurium or low dose of rocuronium can be safely used for good quality of endotracheal intubation and smooth recovery in elective paediatric patients coming for short ENT operations.

Reversal of Partial Neuromuscular Block and the Ventilatory Response to Hypoxia: A Randomized Controlled Trial in Healthy Volunteers.

The ventilatory response to hypoxia is a critical reflex that is impaired by neuromuscular blocking drugs. However, the degree to which this reflex is restored after reversal of blockade is unknown. Despite full reversal of neuromuscular blockade at the thumb using different drug classes, this hypoxic chemoreflex is not fully restored. The ventilatory response to hypoxia is a life-saving chemoreflex originating at the carotid bodies that is impaired by nondepolarizing neuromuscular blocking agents. This study evaluated the effect of three strategies for reversal of a partial neuromuscular block on ventilatory control in 34 healthy male volunteers on the chemoreflex. The hypothesis was that the hypoxic ventilatory response is fully restored following the return to a train-of-four ratio of 1. In this single-center, experimental, randomized, controlled trial, ventilatory responses to 5-min hypoxia (oxygen saturation, 80 ± 2%) and ventilation at hyperoxic isohypercapnia (end-tidal carbon dioxide concentration, 55 mmHg) were obtained at baseline, during rocuronium-induced partial neuromuscular block (train-of-four ratio of 0.7 measured at the adductor pollicis muscle by electromyography), and following reversal until the train-of-four ratio reached unity with placebo (n = 12), 1 mg neostigmine/0.5 mg atropine (n = 11), or 2 mg/kg sugammadex (n = 11). This study confirmed that low-dose rocuronium reduced the ventilatory response to hypoxia from 0.55 ± 0.22 (baseline) to 0.31 ± 0.21 l · min · % (train-of-four ratio, 0.7; P < 0.001). Following full reversal as measured at the thumb, there was persistent residual blunting of the hypoxic ventilatory response (0.45 ± 0.16 l · min · %; train-of-four ratio, 1.0; P < 0.001). Treatment effect was not significant (analysis of covariance, P = 0.299) with chemoreflex impairment in 5 (45%) subjects following sugammadex reversal, in 7 subjects (64%) following neostigmine reversal, and in 10 subjects (83%) after spontaneous reversal to a train-of-four ratio of 1. Despite full reversal of partial neuromuscular block at the thumb, impairment of the peripheral chemoreflex may persist at train-of-four ratios greater than 0.9 following reversal with neostigmine and sugammadex or spontaneous recovery of the neuromuscular block.

Subparalyzing Doses of Rocuronium Reduce Muscular Endurance without Detectable Effect on Single Twitch Height in Awake Subjects.

Purpose To test the hypothesis that a low-dose rocuronium acts mainly by means of reducing muscular endurance rather than by reducing momentary force. Methods In a randomized placebo-controlled double-blinded study, eight healthy volunteers were studied in two sets of experiments. In the first set, the subjects made a sustained maximum effort with the dominant hand for 80 seconds while squeezing an electronic handgrip dynamometer at three minutes after intravenous administration of placebo, 0.04 or 0.08 mg/kg rocuronium. Handgrip force at initiation of testing (maximum handgrip force) and after 60 seconds was evaluated. In the second set, the ulnar nerve of the subjects was electrically stimulated every tenth second for at least 10 and a maximum of 30 minutes following the administration of placebo and 0.08 mg/kg rocuronium. Single twitch height of the adductor pollicis muscle was recorded. Results There was no significant difference in the effect on maximum handgrip force at time 0 between the three different doses of rocuronium. As compared with placebo, handgrip force after 0.08 mg/kg rocuronium was reduced to approximately a third at 60 seconds (214 N (120–278) vs. 69 (30–166); p=0.008), whereas only a slight reduction was seen after 0.04 mg/kg (187 (124–256); p=0.016). Based on these results, the sustained handgrip force after 0.2 mg/kg at 60 seconds was calculated to be 1.27% (95% CI [0.40, 4.03]) of the maximum force of placebo. No effect on single twitch height after 0.08 mg/kg rocuronium at four minutes after drug administration could be detected. Conclusions Subparalyzing doses of rocuronium show a distinct effect on muscular endurance as opposed to momentary force. The findings support the hypothesis that low doses of rocuronium act mainly by reducing muscular endurance, thereby facilitating, for example, tracheal intubation.

Effect of different doses of ketamine with low-dose rocuronium on intubation conditions in children: prospective randomized double blind trial.

The effect of ketamine on intubation condition, when used as an induction agent with low-dose rocuronium, is unknown. This study aimed to compare the effects of three doses of ketamine used with 0.3 mg/kg rocuronium and 1 µg/kg fentanyl on intubation conditions in children undergoing short elective surgery. The study was performed as a prospective, randomized double-blind clinical trial. A total of 60 children aged 2 to 12 years, who were scheduled for inguinal herniorrhaphy under general anesthesia, were randomly allocated into three groups on the basis of ketamine dose: 1 mg/kg (Group K1, n = 20), 1.5 mg/kg (Group K1.5, n = 20), and 2 mg/kg (Group K2, n = 20). The primary outcome was the intubation condition. Other assessments included hemodynamic data, recovery profile, adverse events in the postanesthetic care unit (PACU) and use of fentanyl as a rescue analgesic in the PACU were also assessed. The occurrence of a clinically acceptable intubation condition increased with the use of an increased dose (≥ 1.5 mg/kg) (K1/K1.5/K2: 30%/65%/65%; p=0.038, for trends p=0.028). Hemodynamic data, recovery profile and adverse events in PACU showed no difference among groups. Fentanyl dose used in the PACU was higher in K1 than K2 and the number of patients requiring rescue analgesics in the PACU decreased in accordance with the dose of ketamine (K1/K1.5/K2: 30%/15%/0%; p=.031, for trends p=0.013). Different intubation conditions were observed on the basis of ketamine dose used in conjunction with 0.3 mg/kg rocuronium and fentanyl 1 µg/kg. Ketamine dose ≥ 1.5 mg/kg with low-dose rocuronium should be used to improve intubation conditions in pediatrics.

A comparative study of different doses of ephedrine on intubating conditions and haemodynamics using propofol and low dose rocuronium

A comparative study of different doses of ephedrine on intubating conditions and haemodynamics using propofol and low dose rocuronium

Rocuronium versus cisatracurium as adjuvants to local anesthetic in peribulbar-induced akinesia

Background and objectives Peribulbar anesthesia is widely used in cataract surgery, but the beginning of akinesia is much slower and slower compared with retrobulbar technique. The effect of using adjuvant to the peribulbar block for the development of improved conditions in the absence of any adverse effects and in fastening the onset of akinesia has been implicated. We investigate the effect of the use of rocuronium, cisatracurium, and hyaluronidase as adjuvants for the local anesthetic on peribulbar-induced akinesia in relation to the grade of akinesia. Patients and methods A total of 135 women were assigned for cataract surgery to three groups (45 patients in each group), who received local eye anesthesia of a mixture (8 ml) containing equal amounts of Marcaine 0.5% and lidocaine 2%, containing hyaluronidase 15 IU/ml plus 0.5 ml saline 0.9% (group C); a mixture (8 ml) containing equal parts of 0.5% Marcaine and 2% lidocaine plus 0.5 ml cisatracurium (1 mg) (group A); and a mixture (8 ml) containing equal parts of 0.5% Marcaine, 2% lidocaine plus 0.5 ml rocuronium (5 mg) (group R). Lid akinesia, globe akinesia, hemodynamics, and adverse effects were evaluated among groups. Results After 1 min of injection, the number of patients reaching total akinesia was 15 (33%) with rocuronium, nine (20%) with cisatracurium, and zero (0%) in the control group. After 3 min of injection, the total number of individuals achieving total immobility was 21 (46%) with rocuronium, 15 (33%) with cisatracurium, and six (13%) in the control group. After 5 min of injection, the number of patients reaching total akinesia was 33 (73%) with rocuronium, 27 (60%) with cisatracurium, and 21 (46%) with the control group. At the 10th minute after injection, the number of individuals reaching total akinesia was 39 (86%) with rocuronium, 33 (73%) with cisatracurium, and 30 (66%) with control. In groups of rocuronium and cisatracurium, the total akinesia is relatively more frequent than in the control group. The number of patients with complete akinesia was higher in the rocuronium group after 10 min than in the cisatracurium and control groups, but there was no statistically significant difference among the three groups regarding lid akinesia. We did not notice any adverse effects related to the peribulbar block or the drugs used during the study. Conclusion This study demonstrated that addition of low-dose cisatracurium and rocuronium to the anesthetic drug is recommended to improve the quality of akinesia especially when hyaluronidase is not added.

The effect of low-dose rocuronium on rapid tracheal intubation using a video laryngoscope: A randomized double blind controlled study.

Background:The aim of this study was to investigate the clinical effectiveness of rocuronium in low doses on conditions during rapid tracheal intubation using video laryngoscope.Methods:Ninety-eight patients undergoing otolaryngologic surgery were randomly divided into 2 groups: group L using 0.3 mg/kg of rocuronium intravenously (n = 49) and group C using 0.6 mg/kg of rocuronium (n = 49). Sixty seconds after rocuronium administration, tracheal intubation was performed using a video laryngoscope. The overall intubation condition was evaluated along with specific conditions, including laryngoscopy condition, vocal cord position, and intubation response. Intubation profiles, including Cormack–Lehane grade, 1st attempt success rate, and intubation time, were also evaluated.Results:Overall intubation conditions showed a significant difference between group L and group C (P = .003). Although the incidence of vigorous response after tracheal intubation was higher in group L than in group C (P = .022), laryngoscopy condition and vocal cord position were similar between the 2 groups (P = .145 and .070, respectively). Intubation profiles showed no differences between the 2 groups. The frequency and amount of additional rocuronium administration during surgery were also similar.Conclusions:Low-dose rocuronium provided significantly worse overall intubation conditions compared to the conventional dose of rocuronium for rapid tracheal intubation. However, when using a video laryngoscope, it may provide clinically acceptable laryngeal muscle relaxation.

Efficacy of low-dose rocuronium in reducing induction dose of propofol in classic laryngeal mask airway insertion in one day case surgery

Background The amount of sedation and muscle relaxation of the jaw may affect complications caused by laryngeal mask airway (LMA). The aim of this study is to evaluate the effect of low-dose rocuronium on reducing the induction dose of propofol needed for LMA insertion in patients undergoing one day case surgery and its effect on LMA insertion conditions and complications. Patients and methods Sixty patients were included in this randomized double-blind clinical study. Patients were divided into two groups: the control group (group I) received intravenous fentanyl 1 μg/kg and midazolam 0.05 mg/kg, 5 ml normal saline (placebo) and propofol (n=30). The second (study) group (group II) receive intravenous fentanyl 1 μg/kg and midazolam 0.05 mg/kg, 0.15 mg/kg rocuronium diluted in 5 ml normal saline and propofol (n=30). Propofol dose was adjusted by loss of movements to maximum jaw thrust. Demographic data, American Society of Anesthesiologist physical status, duration of surgery, duration of anesthesia, systolic and diastolic blood pressures, heart rate measurements (basal readings were recorded as well as immediately after induction then after 1 min till the fifth minute), induction dose of propofol, success rate of LMA insertion from the first time, speed of insertion, and any complications were recorded. Results There were no significant differences between both groups regarding demographic data, American Society of Anesthesiologist physical status, duration of surgery, duration of anesthesia, heart rate, success rate of insertion from the first time and complications. On the contrary, there were significant statistical differences between both groups regarding induction dose of propofol (P Conclusion Using low-dose rocuronium (0.15 mg/kg) increases jaw relaxation, reduces propofol requirements in induction for LMA insertion, decreases the time needed for its insertion, and relatively decreases postoperative complications related to LMA insertion.

Correction.

AnaesthesiaVolume 72, Issue 11 p. 1427-1427 CorrectionsFree Access Correction This article corrects the following: Comparison of reversal with neostigmine of low-dose rocuronium vs. reversal with sugammadex of high-dose rocuronium for a short procedure E. S. Choi, A. Y. Oh, B. W. Koo, J. W. Hwang, J. W. Han, K. S. Seo, S. H. Ahn, W. J. Jeong, Volume 72Issue 10Anaesthesia pages: 1185-1190 First Published online: May 11, 2017 First published: 19 October 2017 https://doi.org/10.1111/anae.14107AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL In the article by Choi et al. 1, there were 2 errors in the following sentence in the Summary section (indicated by underline): The onset of neuromuscular block was more rapid, and intubation conditions and ease of intra-operative laryngoscopy were more favourable, and the satisfaction score was lower in the moderate block group compared with the deep block group. The correct sentence should be: The onset of neuromuscular block was slower, and intubation conditions and ease of intra-operative laryngoscopy were less favourable, and the satisfaction score was lower in the moderate block group compared with the deep block group. Reference 1Choi ES, Oh AY, Koo BW, et al. Comparison of reversal with neostigmine of low-dose rocuronium vs. reversal with sugammadex of high-dose rocuronium for a short procedure. Anaesthesia 2017; 72: 1185– 90. Volume72, Issue11November 2017Pages 1427-1427 ReferencesRelatedInformation

Magnesium sulfate accelerates the onset of low-dose rocuronium in patients undergoing laryngeal microsurgery

Study objectiveWe evaluated the effect of magnesium sulfate—an enhancer of neuromuscular blockade—on onset and duration of low dose of rocuronium, and on operating conditions during laryngeal microsurgery. DesignRandomized, prospective, double-blinded study. PatientsEighty-four patients scheduled for elective laryngeal microsurgery. InterventionsPatients were randomly allocated to receive different doses of rocuronium: 0.6 mg/kg (group C, n=28), 0.45 mg/kg (group LR, n=28), or 0.45 mg/kg plus magnesium sulfate 30 mg/kg (group LM, n=28). MeasurementsWe measured the onset time and duration of action of rocuronium, and evaluated the surgeon's satisfaction with the operating conditions. Main resultsGroup LR showed significantly delayed onset time (group C: 87±22 seconds, group LR: 127±47 seconds, and group LM: 89±32 seconds; P=.001) and maximal suppression than did other groups (group C: 102±30 seconds, group LR: 155±66 seconds, and group LM: 105±36 seconds; P=.002). Duration of action of rocuronium was significantly longer in group C than in other groups (group C: 39±7 minutes, group LR: 28±8 minutes, group LRM: 31±8 minutes; P<.001). Laryngoscope placement score (P=.002), surgeon's satisfaction (P=.005), and sore throat (P=.035) were significantly worse in group LR. ConclusionsMagnesium sulfate 30 mg/kg accelerated the onset and improved operating conditions of low-dose rocuronium without prolongation of action.

Adding low dose rocuronium to local anesthetic mixture: Effect on quality of peribulbar blockade for vitreoretinal surgery

BackgroundThe purpose of this study was to assess the effect of adding low dose rocuronium to local anesthetic solution on the quality of peribulbar blockade for vitreoretinal (VR) surgery.Methods80 consecutive adult patients scheduled for VR surgery were enrolled in this double-blind randomized clinical trial. Patients were categorized randomly into 2 equal groups: group C (control group) received local anesthetic mixture (4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and hyaluronidase “30 U/ml”) plus 0.5 ml normal saline, and group S (study group) received the same local anesthetic mixture plus 5 mg (0.5 ml) rocuronium. Globe and lid akinesia were assessed 15 min after injection, and supplemental peribulbar blockade was done in case of inadequate analgesia and or akinesia. Intraoperatively, supplementary sub-Tenon infiltration was performed in case of inadequate analgesia and/or akinesia. Measurement data included rate of supplementation, analgesic efficacy, time to first sub-Tenon infiltration, and total anesthetic volume. Major complications, and patient’s and surgeon’s satisfaction were also recorded.ResultsThe adequacy of peribulbar blockade 15 min after injection was comparable in both groups. Rate of supplementary sub-Tenon infiltration was lower in the rocuronium group which is statistically significant (15 injections versus 53 injections in the control group). Time to first sub-Tenon infiltration was significantly prolonged in the rocuronium group (90.4 + 11.8 versus 60.2 + 9.2 in the control group). The total anesthetic volume injected was significantly lower in the rocuronium group (13.2 + 0.6 versus 20.6 + 0.8 in the control group). There were no major systemic or local complications in both groups. Patient’s and surgeon’s satisfaction was significantly higher in the rocuronium group.ConclusionAdding low dose rocuronium to local anesthetics prolongs duration of peribulbar anesthesia and offers an optimal surgical condition without serious adverse effects for patients undergoing VR surgery.

Safety and efficacy of low-dose rocuronium in awake fiberoptic intubation

Background As it can be manually manipulated and facilitates visualization around corners, use of an awake flexible fiberoptic bronchoscope has been established as the gold standard for difficult intubation since the 1960s. It is advisable to use conscious sedation to make the procedure easier and more tolerable. The aim of this study was to evaluate the safety and efficacy of using low-dose rocuronium in awake fiberoptic intubation. Patients and methods In an experimental prospective study, 90 patients of ASA grades I and II scheduled for elective surgery, with age range of 18-60 years, received sedation for awake fiberoptic intubation. The patients were divided into three groups of 30 patients each: group I received 1 mg/kg fentanyl and 0.05 mg/kg midazolam; group II received 1 mg/kg fentanyl, 0.05 mg/kg midazolam, and 0.05 mg/kg rocuronium; and group III received 1 mg/kg fentanyl, 0.05 mg/kg midazolam, and 0.1 mg/kg rocuronium. Hemodynamic changes, hypoxia, hypercapnia, sedation score, position of vocal cords, time taken for intubation, cough, sore throat, vomiting, bleeding in airways, bronchospasm, patient discomfort, and any other side effects were noticed and recorded. Results Sedation score in group III was significantly higher than in the other two groups ( P = 0.04). There was significant decrease in time taken to intubate in group III when compared with group I or group II ( P = 0.041). Patient satisfaction in group III was significantly higher than in group I ( P = 0.02). Incidence of cough in group I was significantly high when compared with groups II and III ( P = 0.001). No significant differences were seen between groups regarding hemodynamic changes, hypoxia, hypercapnia, position of vocal cords, cough, sore throat, bleeding, bronchospasm, vomiting, and vagal faint. Conclusion Addition of low-dose rocuronium at 0.1 mg/kg to fentanyl and midazolam during awake fiberoptic intubation is more efficient, safer, and better than addition of 0.05 mg/kg rocuronium or usage of fentanyl and midazolam alone with regard to sedation score, time taken for intubation, and patient satisfaction.