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Prolonged neuromuscular block after rocuronium administration in laparoscopic pyloromyotomy patients: A retrospective bayesian regression analysis
- Source :
- Paediatric anaesthesiaREFERENCES. 31(3)
- Publication Year :
- 2020
-
Abstract
- Background Infants undergoing pyloromyotomy are at a high risk of aspiration, making rapid sequence induction the preferred method of induction. Since succinylcholine use in infants can be associated with complications, rocuronium is frequently substituted despite its prolonged duration of action. Aims To examine the likelihood of non-reversibility to neostigmine at the end of surgery in laparoscopic pyloromyotomies and its correlation to both rocuronium dose and out of operating room time. Methods Patients who underwent laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis, received rocuronium, and were reversed with neostigmine were included. Bayesian multivariable logistic regression was utilized to determine the probability of non-reversibility, and Bayesian multivariable median regression was performed to ascertain the correlation between out of operating room time and non-reversibility. Results 306 patients were analyzed with a median surgical duration of 19 min (interquartile range 16 to 23). 74% received succinylcholine for intubation followed by rocuronium, and the remaining received rocuronium alone. The median rocuronium dose was 0.41 mg/kg (interquartile range 0.27 - 0.56 mg/kg). Prolonged block occurred in 68 (22.2%) patients. There was a non-trivial probability of prolonged block with low rocuronium doses, and each 0.1 mg/kg increase in total rocuronium dose was associated with an odds ratio of 1.36 (95% credible interval: 1.17-1.58) of neostigmine non-reversibility at the end of surgery. Non-reversibility was correlated with a substantial increase in median out of operating room time (13.4 min, 95% credible interval: 5.5-20.8 min), which was compounded by high rocuronium dosing (2.2 min increase per 0.1 mg/kg for doses greater than 0.5 mg/kg, 95% credible interval: 0.7-3.6 min). Conclusion Prolonged blockade can occur from rocuronium administration in infants undergoing pyloromyotomy even at low doses. Therefore, consideration of appropriate rocuronium dosing or the use of sugammadex should be considered.
- Subjects :
- medicine.medical_treatment
Pyloromyotomy
Sugammadex
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
Interquartile range
030225 pediatrics
medicine
Intubation
Humans
Dosing
Androstanols
Rocuronium
Retrospective Studies
business.industry
Infant
Bayes Theorem
Rapid sequence induction
Neostigmine
Anesthesiology and Pain Medicine
Anesthesia
Pediatrics, Perinatology and Child Health
Neuromuscular Blockade
Regression Analysis
Laparoscopy
business
medicine.drug
Neuromuscular Nondepolarizing Agents
Subjects
Details
- ISSN :
- 14609592
- Volume :
- 31
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Paediatric anaesthesiaREFERENCES
- Accession number :
- edsair.doi.dedup.....23c41f182c1595eac51009068bfbe61a