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An evaluation of the use of rocuronium and sugammedex for general anaesthesia for caesarean section

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An Evaluation Of The Use Of Rocuronium And Sugammedex For General Anaesthesia For Caesarean Delivery
LAM Stacey, M Turner
Department of Anaesthesia, Royal Gwent Hospital, Newport, UK 

Introduction:

The ongoing use of succinylcholine for RSI in obstetrics has come under scrutiny. Rocuronium has gained popularity due to its speed of onset and the availability of sugammedex for reversal1. Our local guidelines permit the use of sugammadex in cases where residual blockade could have grave consequences, so its use in obstetrics is justified.

Methods:

One consultant anaesthetised 18 consecutive cases of GA for caesarian delivery (CD) between 2013 and 2017. All patients received propofol and rocuronium on induction. Patients received an approximated dose of 0.6-1 mg/kg rocuronium. Maintenance was with sevoflourane in O2 and N2O. Sugammedex was administered after the end of surgery. Train of Four (TOF) was assessed pre and post reversal. Time from induction to reversal and to extubation was recorded. Adverse incidents were noted.

Results:

A total of 18 cases were examined. Patient weight and duration of procedure varied greatly. All patients had four full twitches post reversal, pre-extubation. The range of reversal to extubation was 30s - 5min. Sugammadex 200 mg was a sufficient dose to reverse neuromuscular blockade in all but two patients, irrespective of weight. One patient required additional reversal, and the other 300 mg sugammadex. Both patients were receiving MgSO4 infusions.

There were no cases of difficult intubation. Airway complications were minimal: one case of laryngospasm and three patients that coughed after extubation.

Discussion:

Current local sugammedex guidelines preclude the use of sugammadex as routine reversal from NMB. GA for CD is not routine practice and rapid return of muscle power and airway reflexes is essential. This small case series appears to support the use of this combination to enhance the outcome of women undergoing obstetric GA and may be preferable to current practice. A dose of 200 mg sugammadex appears suitable for most women, but extra care should be afforded to those on MgSO4 infusions.

Reference

1. Chaggar RS, Campbell JP. The future of general anaesthesia in obstetrics. BJA Education. 2016; Vol 17, Issue 3, 79-83. 

 

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