European Journal of Molecular & Clinical Medicine

Here we are presenting anaesthetic management of 61-Year-old male patient with Cardiac Resynchronization Therapy Defibrillator (CRTD) in situ, posted for Open Reduction Internal Fixation (ORIF) of left tibia Fibula, without interfering in the function of CRT defibrillator.Right selection of mode of anesthesia and changing the CRTD mode into asynchronous one are few of all the important factors that could be practiced Perioperative care in CRTD implanted patients. General anesthesia is avoided and Sab-Arachnoid Block anaesthesia causing sympathetic blockage to avoid hypotension should be preferred. Patient was preoxygenated and premedicated with 2 mgbutorphanol and 1 mg midazolam following which modified rapid-sequence induction was done using 100 mg propofol and 50 mg rocuroniumintaveously. Maintenance of anaesthesia was done with oxygen, nitrous oxide, isoflurane and rocuronium. Patient surgery completed successfully without any post-operative complications.

Background: Rocuronium, like succinylcholine, has a rapid onset of neuromuscular blockade; but, unlike succinylcholine, rocuronium does not have the deleterious effects that are associated with the use of the latter. Nevertheless, its usage is restricted because of its protracted activity. The purpose of this study was to determine whether or not lowering the intubating dose of rocuronium shortened its duration of action while still providing intubating conditions that were clinically acceptable. This was a prospective, randomised, and blinded study for both participants and observers.
Material and Methods: One hundred Indian patients aged between 18 and 65 years who were scheduled for elective surgery were randomly assigned to one of the four rocuronium groups (rocuronium dose of 0.6 mg/kg intubated at 60 s or at 90 s, rocuronium 0.9 mg/kg intubated at 60 s or at 90 s) or succinylcholine group (succinylcholine dose of 1.5 mg/kg intubated at 60 s). Intubating conditions Analysis of variance (ANOVA), Chi-square test, repeated measures analysis of variance (ANOVA), and Mann–Whitney U test were the four statistical tests that were carried out.
Results: Intubating conditions were deemed clinically acceptable in 35% of subjects at 60 seconds and 60% of subjects at 90 seconds when rocuronium was administered in a dosage of 0.6 mg/kg; however, when rocuronium was administered in a dosage of 0.9 mg/kg, intubating conditions were deemed clinically acceptable in 80% of subjects at 60 seconds and 100% of subjects at 90 seconds.
Conclusion: When administered at a dose of 0.6 mg/kg, rocuronium did not produce clinically acceptable intubating circumstances at either 60 or 90 seconds, although it has a shorter duration of action. It takes approximately the same amount of succinylcholine, 0.9 mg/kg, for rocuronium to provide clinically acceptable intubating circumstances as it does for succinylcholine, 1.5 mg/kg.

Background: Rocuronium bromide, a mono quaternary amino steroid with a short onset and an intermediate duration of action, is currently one of the most commonly used neuromuscular blocking agent. In common with vecuronium, hepatic uptake & biliary excretion have been suggested to be the main mechanism of rocuronium metabolism with renal elimination accounting for 10-20% of its overall excretion. This study was conducted to investigate the neuromuscular effects of 0.6mg/kg rocuronium under general anaesthesia in patients with and without renal failure.
Methodology: This prospective observational study includes 110 patients (pts.) divided into two groups, Group ‘S’ (n=55) pts. with renal failure and Group ‘C’ (n=55) without renal failure. Neuromuscular transmission was monitored, parameters recorded were onset, time to maximal block, time to recovery of first twitch response to 25%, 50%, 75% and 90% of base line, time to recovery of train-of-four (TOF) ratio of 70% and recovery index 25% - 75%.
Results: In both the groups demographic data were similar. Both onset time and maximum block for rocuronium were comparable in group S and group C, found not significant. Time to recovery of first twitch response to 25%, 50%, 75% and 90% of baseline, time for recovery of TOF ratio to 70% and recovery index were significantly prolonged in group S compared to group C.
Conclusion: Rocuronium can be used with caution in patients with renal disease and monitoring of neuromuscular block in this group of patients is essential.

Background: Rocuronium Bromide, an intermediate acting amino steroid NMDR, is five to seven times less potent than Vecuronium used in this study was to compare time of onset, conditions of tracheal intubation, duration of action and hemodynamic parametres, either of the drugs are used to produce muscular paralysis.
Materials & Methods: Study was carried out by taking 60 adult patients, undergoing different elective abdominal surgery under general anaesthesia, in age group of 15-60 years with ASA physical status I or II,30 patients received 0.6 mg/kg of Rocuronium bromide as Intubating dose and the other 30 patients received 0.1 mg/kg of Vecuronium bromide. Then neuromuscular blockade, endotracheal intubation of two non-depolarizing muscle relaxants were evaluated using a TOF in adductor pollicis muscles.
Results: In both the groups intubating conditions were either excellent or good. Intubating conditions with Rocuronium group were excellent in 86.67% and good in 13.33% patients while in Vecuronium group, intubating condition were excellent in 80% and good in 20% patients, which were comparable and statistically not significant (p=0.488). The onset of action of Rocuronium was found to be rapid compared to Vecuronium group with high statistical significance. (p=0.000).