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Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Dahaba, AA; Bornemann, H; Hopfgartner, E; Ohran, M; Kocher, K; Liebmann, M; Wilfinger, G; Metzler, H.
Effect of sugammadex or neostigmine neuromuscular block reversal on bispectral index monitoring of propofol/remifentanil anaesthesia.
Br J Anaesth. 2012; 108(4): 602-606.
Doi: 10.1093/bja/aer495
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- Co-authors Med Uni Graz
- Bornemann-Cimenti Helmar
- Hopfgartner Elke Michaela
- Kocher Karl
- Metzler Helfried
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- Abstract:
- BACKGROUND: Sugammadex is a modified ã-cyclodextrin with a novel mechanism of action for reversing the steroidal neuromuscular blocking agent rocuronium. Bispectral index (BIS) is an EEG-derived measure which can be sensitive to frontal electromyographic (EMG) artifacts. We compared BIS values before and after sugammadex or neostigmine neuromuscular block (NMB) reversal in patients with or without high EMG activity. METHODS: During stable propofol/remifentanil anaesthesia and rocuronium-induced block, 48 patients were randomly allocated to receive sugammadex 4 mg kg(-1) or neostigmine 50 ìg kg(-1)/glycopyrrolate 10 ìg kg(-1), 10 min after the end of surgery. RESULTS: Five minutes after sugammadex administration, mean BIS 50.1 (10.3) increased (P=0.018) to 61.7 (7.9) in 11 patients with high EMG activity. In contrast, BIS 49.3 (4.9) remained at 51.9 (5.4) in 13 patients who had no EMG activity. Fifteen minutes after neostigmine administration, mean BIS 51.9 (8.1) increased (P=0.007) to 63.9 (8.1) in 13 patients who had reappearance of muscle activity. However, in 11 patients who had no EMG activity, BIS 52.3 (7.4) remained at 53.3 (6.8). There was no significant difference between the sugammadex and neostigmine groups over time. CONCLUSIONS: We have shown that reversal of NMB with sugammadex or neostigmine increased BIS values dependent on the presence of EMG activity. Thus, the effect of muscle activity reappearance during rocuronium NMB reversal spuriously increasing the BIS value should be taken into consideration when relying on BIS monitoring for evaluating propofol/remifentanil recovery.
- Find related publications in this database (using NLM MeSH Indexing)
- Adolescent -
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- Androstanols - antagonists and inhibitors
- Anesthesia - methods
- Anesthesia Recovery Period -
- Anesthetics, Intravenous - pharmacology
- Cholinesterase Inhibitors - pharmacology
- Electroencephalography - drug effects
- Electromyography - drug effects
- Female -
- Humans -
- Male -
- Middle Aged -
- Monitoring, Physiologic - methods
- Neostigmine - pharmacology
- Neuromuscular Blockade - methods
- Neuromuscular Nondepolarizing Agents - antagonists and inhibitors
- Piperidines - pharmacology
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- Find related publications in this database (Keywords)
- anaesthesia
- depth
- measurement techniques
- mechanomyography
- measurement techniques
- neuromuscular block
- monitoring
- intraoperative
- monitoring
- neuromuscular function
- neuromuscular blocking agents
- NM relaxant
- reversal