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  • 1
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    Recovery of lower oesophageal barrier function: a pilot study comparing a mixture of atropine and neostigmine and sugammadex : A randomised controlled pilot study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  European Journal of Anaesthesiology Vol. 38, No. 8 ( 2021-08), p. 856-864
    Details
    In: European Journal of Anaesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 8 ( 2021-08), p. 856-864
    Abstract: The lower oesophageal sphincter (LOS) barrier serves to prevent regurgitation of gastric contents. Although general anaesthesia depresses its function, its recovery process during emergence from anaesthesia has not been systematically examined. OBJECTIVE To explore whether recovery of lower oesophageal barrier function differed between patients receiving a mixture of 1 mg atropine and 2 mg neostigmine and those receiving 2 mg kg −1 sugammadex during emergence from anaesthesia. DESIGN An unblinded randomised controlled pilot study. SETTING A single university hospital from January 2016 to December 2018. PATIENTS A total of 20 non-obese adult females undergoing minor surgery. INTERVENTION The patients were randomly assigned to a group either receiving atropine and neostigmine or sugammadex for reversal of rocuronium. MAIN OUTCOME MEASURES Through use of the high-resolution manometry technique, the lower oesophageal barrier pressure (P BAR : primary variable) defined as a pressure difference between pressures at the LOS and the stomach was measured at five distinguishable time points during emergence from total intravenous anaesthesia. A mixed effects model for repeated measures was used to test the hypothesis. RESULTS In all patients baseline P BAR values were positive even under muscle paralysis and general anaesthesia before administration of reversal agents, and did not differ between the groups ( P  = 0.299). During recovery from muscle paralysis and general anaesthesia, P BAR (mean ± SD) significantly increased ( P  = 0.004) from 17.0 ± 2.9 to 21.0 ± 5.0 mmHg in the atropine and neostigmine group ( n  = 8) and from 19.1 ± 9.0 to 24.5 ± 12.7 mmHg in the sugammadex group ( n  = 11). P BAR significantly increased immediately after return of consciousness in both groups, whereas return of muscle tone, lightening of anaesthesia and tracheal extubation did not change it. CONCLUSION Recovery of the lower oesophageal barrier function does not differ between patients receiving either atropine and neostigmine or sugammadex and is completed after recovery of consciousness from general anaesthesia. TRIAL REGISTRATION UMIN Clinical Trials Registry: UMIN000020500: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows & action=brows & recptno=R000023594 & type=summary & language=E
    Type of Medium: Online Resource
    ISSN: 0265-0215 , 1365-2346
    URL: Article
    DOI: 10.1097/EJA.0000000000001464
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2004964-X
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  • 2
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    Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Anesthesiology Vol. 129, No. 5 ( 2018-11-01), p. 901-911
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    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 129, No. 5 ( 2018-11-01), p. 901-911
    Abstract: Complete recovery from rocuronium-induced muscle paralysis with sugammadex is reported to be delayed in elderly patients. The authors tested a hypothesis that recovery from deep neuromuscular block with low-dose sugammadex is slower (primary hypothesis) and incidence of recurarization is higher (secondary hypothesis) in elderly patients than in nonelderly patients. Methods In anesthetized elderly (n = 20; 76.9 ± 5.0 yr of age) and nonelderly patients (n = 20; 53.7 ± 12.8 yr of age) under deep paralysis with rocuronium, change of train-of-four ratio per minute (primary outcome variable) was measured with an acceleromyograph neuromuscular monitor during spontaneous recovery from rocuronium-induced muscle paralysis (0.6 mg/kg) and after infusion of low-dose sugammadex (50 µg · kg-1 · min-1). Recurarization was defined as the negative change of train-of-four ratio. Results Spontaneous train-of-four ratio recovery rate was significantly slower in the elderly group (median [25th percentile, 75th percentile]: 1.89 [1.22, 2.90] %/min) than in the nonelderly group (3.45 [1.96, 4.25] %/min, P = 0.024). Train-of-four ratio change rate in response to low-dose sugammadex was significantly slower in elderly (0.55 [–0.29, 1.54] %/min) than in the nonelderly group (1.68 [0.73, 3.13] %/min, P = 0.024). Incidence of recurarization was significantly higher in the elderly group than in the nonelderly group (35% vs. 5%, P = 0.044). Multiple linear regression analyses indicate that slower spontaneous train-of-four ratio recovery rate and impaired renal function are two major contributing factors that decrease train-of-four ratio change rate in response to low-dose sugammadex. Conclusions Elderly patients are at greater risk for recurarization and residual muscle paralysis when low-dose sugammadex is administered.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000002412
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2016092-6
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  • 3
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    Hypercapnia versus normocapnia for emergence from desflurane anaesthesia : Single-blinded randomised controlled study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  European Journal of Anaesthesiology Vol. 38, No. 11 ( 2021-11), p. 1148-1157
    Details
    In: European Journal of Anaesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 11 ( 2021-11), p. 1148-1157
    Abstract: Rapid emergence from general anaesthesia is desirable only if safety is not sacrificed. Mechanical hyperventilation during hypercapnia produced by carbon dioxide infusion into the inspired gas mixture or by rebreathing was reported to shorten emergence time from inhalation anaesthesia. OBJECTIVES To test the hypothesis that hypercapnia produced by hypoventilation before desflurane cessation shortens emergence time from general anaesthesia (primary hypothesis) and reduces undesirable cardiorespiratory events. DESIGN A single-blinded randomised controlled study. SETTING A single university hospital. PATIENTS Fifty adult patients undergoing elective abdominal surgery under general anaesthesia using desflurane inhalation and intra-operative epidural anaesthesia. INTERVENTION The patients were randomly assigned to either the normocapnia or hypercapnia group. MAIN OUTCOME MEASURES Emergence time from desflurane anaesthesia and comparison of the incidence of 11 predefined undesirable cardiorespiratory events during and after emergence from anaesthesia between the groups. RESULTS Forty-six patients were included in the analysis. End-tidal carbon dioxide concentrations at cessation of desflurane were 35 ± 6 mmHg (mean ± SD) and 52 ± 6 mmHg in normocapnia ( n  = 23) and hypercapnia groups ( n  = 23), respectively. Emergence time was significantly faster in the hypercapnia group than the normocapnia group: 9.4 ± 2.4 min, hypercapnia: 5.5 ± 2.6 min, ( P   〈  0.001) with a difference of 3.8 min on average (95% CI: 2.4 to 5.3). Spontaneous breathing established before recovery of consciousness was more evident in hypercapnia patients (normocapnia: 13%, hypercapnia: 96%, P   〈  0.001). Hypercapnia patients had more episodes of bradypnoea and apnoea before emergence of consciousness. In contrast, after tracheal extubation, incidences of bradypnoea and hypopnoea were more common in the normocapnia group. Undesirable cardiovascular events were not common, and no group differences were observed during emergence and postextubation periods. CONCLUSION Hypoventilation-induced hypercapnia before desflurane cessation shortens the emergence time without causing additional clinically significant undesirable events. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN000020143) https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows & recptno=R000023266 & language=E
    Type of Medium: Online Resource
    ISSN: 0265-0215 , 1365-2346
    URL: Article
    DOI: 10.1097/EJA.0000000000001574
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2004964-X
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