Chemotherapy alters cisatracurium induced neuromuscular blockade characteristics: A prospective cohort study
Abstract Study objective To compare the characteristics of NMDR induced muscle paralysis in breast cancer patients with and without a history of recent chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) regimen. Design This is a non-randomized prospective cohort study. Setting...
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| Veröffentlicht in: | Journal of clinical anesthesia 2017-02, Vol.36, p.84-87 |
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| creator | Zanjani, Amir Poya, MD Maghsoudloo, Maziar, MD Makarem, Jalil, MD Farokhnia, Fahimeh, MD Fazli, Morteza Khan, Zahid Hussain, MD, FCCM |
| description | Abstract Study objective To compare the characteristics of NMDR induced muscle paralysis in breast cancer patients with and without a history of recent chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) regimen. Design This is a non-randomized prospective cohort study. Setting Operating room of a university-affiliated teaching hospital. Patients Out of a total of 50 patients who had undergone mastectomy, 22 patients were allocated to the “Chemo group” and 28 patients to the “Non-Chemo group”, based on a valid history of recent chemotherapy. Intervention After induction of anesthesia with thiopental and cisatracurium, neuromuscular monitoring was started for all patients. Measurements Initially the time to 100% single-twitch (ST) suppression was measured. Then, the time for the appearance of the first response to post-tetanic count (PTC) stimulation, Train-of-Four (TOF) stimulation, and TOF50% were measured consequently. Main results Time to get STzero was significantly longer in the Chemo group than in the Non-chemo group. Time for the appearance of the first response of PTC and TOF and TOF50% was significantly shorter in the Chemo group than the other group. The mean duration of intense block was 27.66 minutes in the Chemo group versus 42.47 minutes in the Non-chemo group. Conclusion This research demonstrated that in patients having undergone chemotherapy, the effect of NDMRs starts with a longer lag time and finishes earlier too. Thus, these patients are ready for intubation after a longer time. Moreover, we have to repeat cisatracurium injections after shorter intervals to maintain the desired level of blockade. |
| doi_str_mv | 10.1016/j.jclinane.2016.10.025 |
| format | Article |
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Design This is a non-randomized prospective cohort study. Setting Operating room of a university-affiliated teaching hospital. Patients Out of a total of 50 patients who had undergone mastectomy, 22 patients were allocated to the “Chemo group” and 28 patients to the “Non-Chemo group”, based on a valid history of recent chemotherapy. Intervention After induction of anesthesia with thiopental and cisatracurium, neuromuscular monitoring was started for all patients. Measurements Initially the time to 100% single-twitch (ST) suppression was measured. Then, the time for the appearance of the first response to post-tetanic count (PTC) stimulation, Train-of-Four (TOF) stimulation, and TOF50% were measured consequently. Main results Time to get STzero was significantly longer in the Chemo group than in the Non-chemo group. Time for the appearance of the first response of PTC and TOF and TOF50% was significantly shorter in the Chemo group than the other group. The mean duration of intense block was 27.66 minutes in the Chemo group versus 42.47 minutes in the Non-chemo group. Conclusion This research demonstrated that in patients having undergone chemotherapy, the effect of NDMRs starts with a longer lag time and finishes earlier too. Thus, these patients are ready for intubation after a longer time. Moreover, we have to repeat cisatracurium injections after shorter intervals to maintain the desired level of blockade.</description><identifier>ISSN: 0952-8180</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2016.10.025</identifier><identifier>PMID: 28183581</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject><![CDATA[Adult ; Anesthesia & Perioperative Care ; Anesthesia, General - methods ; Antineoplastic Combined Chemotherapy Protocols - pharmacology ; Atracurium - administration & dosage ; Atracurium - analogs & derivatives ; Atracurium - antagonists & inhibitors ; Atracurium - pharmacology ; Body temperature ; Breast cancer ; Breast Neoplasms - drug therapy ; Breast Neoplasms - surgery ; Cancer therapies ; Chemotherapy ; Chemotherapy, Adjuvant ; Cisatracurium ; Cohort analysis ; Cyclophosphamide - pharmacology ; Doxorubicin ; Doxorubicin - pharmacology ; Drug Administration Schedule ; Drug dosages ; Electrolytes ; Female ; Fluorouracil - pharmacology ; General anesthesia ; Humans ; Hypotheses ; Intubation ; Mastectomy ; Metabolism ; Middle Aged ; Monitoring, Intraoperative - methods ; Neoadjuvant Therapy - methods ; Neuromuscular Blockade - methods ; Neuromuscular blocking agents ; Neuromuscular Junction - drug effects ; Neuromuscular Nondepolarizing Agents - administration & dosage ; Neuromuscular Nondepolarizing Agents - antagonists & inhibitors ; Neuromuscular Nondepolarizing Agents - pharmacology ; Pain Medicine ; Prospective Studies]]></subject><ispartof>Journal of clinical anesthesia, 2017-02, Vol.36, p.84-87</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c484t-ba1f98fece70117892900d67dd701fd740562e18ac10ca5beed6119a4de62d313</citedby><cites>FETCH-LOGICAL-c484t-ba1f98fece70117892900d67dd701fd740562e18ac10ca5beed6119a4de62d313</cites><orcidid>0000-0003-3911-2256</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0952818016309321$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28183581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zanjani, Amir Poya, MD</creatorcontrib><creatorcontrib>Maghsoudloo, Maziar, MD</creatorcontrib><creatorcontrib>Makarem, Jalil, MD</creatorcontrib><creatorcontrib>Farokhnia, Fahimeh, MD</creatorcontrib><creatorcontrib>Fazli, Morteza</creatorcontrib><creatorcontrib>Khan, Zahid Hussain, MD, FCCM</creatorcontrib><title>Chemotherapy alters cisatracurium induced neuromuscular blockade characteristics: A prospective cohort study</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>Abstract Study objective To compare the characteristics of NMDR induced muscle paralysis in breast cancer patients with and without a history of recent chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) regimen. Design This is a non-randomized prospective cohort study. Setting Operating room of a university-affiliated teaching hospital. Patients Out of a total of 50 patients who had undergone mastectomy, 22 patients were allocated to the “Chemo group” and 28 patients to the “Non-Chemo group”, based on a valid history of recent chemotherapy. Intervention After induction of anesthesia with thiopental and cisatracurium, neuromuscular monitoring was started for all patients. Measurements Initially the time to 100% single-twitch (ST) suppression was measured. Then, the time for the appearance of the first response to post-tetanic count (PTC) stimulation, Train-of-Four (TOF) stimulation, and TOF50% were measured consequently. Main results Time to get STzero was significantly longer in the Chemo group than in the Non-chemo group. Time for the appearance of the first response of PTC and TOF and TOF50% was significantly shorter in the Chemo group than the other group. The mean duration of intense block was 27.66 minutes in the Chemo group versus 42.47 minutes in the Non-chemo group. Conclusion This research demonstrated that in patients having undergone chemotherapy, the effect of NDMRs starts with a longer lag time and finishes earlier too. Thus, these patients are ready for intubation after a longer time. Moreover, we have to repeat cisatracurium injections after shorter intervals to maintain the desired level of blockade.</description><subject>Adult</subject><subject>Anesthesia & Perioperative Care</subject><subject>Anesthesia, General - methods</subject><subject>Antineoplastic Combined Chemotherapy Protocols - pharmacology</subject><subject>Atracurium - administration & dosage</subject><subject>Atracurium - analogs & derivatives</subject><subject>Atracurium - antagonists & inhibitors</subject><subject>Atracurium - pharmacology</subject><subject>Body temperature</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - surgery</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Chemotherapy, Adjuvant</subject><subject>Cisatracurium</subject><subject>Cohort analysis</subject><subject>Cyclophosphamide - pharmacology</subject><subject>Doxorubicin</subject><subject>Doxorubicin - pharmacology</subject><subject>Drug Administration Schedule</subject><subject>Drug dosages</subject><subject>Electrolytes</subject><subject>Female</subject><subject>Fluorouracil - pharmacology</subject><subject>General anesthesia</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Intubation</subject><subject>Mastectomy</subject><subject>Metabolism</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative - methods</subject><subject>Neoadjuvant Therapy - methods</subject><subject>Neuromuscular Blockade - methods</subject><subject>Neuromuscular blocking agents</subject><subject>Neuromuscular Junction - drug effects</subject><subject>Neuromuscular Nondepolarizing Agents - administration & dosage</subject><subject>Neuromuscular Nondepolarizing Agents - antagonists & inhibitors</subject><subject>Neuromuscular Nondepolarizing Agents - pharmacology</subject><subject>Pain Medicine</subject><subject>Prospective Studies</subject><issn>0952-8180</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkk1v1DAQhi0EokvhL1SRuHDJ4nHixOGAqFZ8SZU4AGfLa0-0TvOx-KPS_nsm2raHXuBkzcwzY8_7mrEr4Fvg0LwftoMd_Wxm3AqKKbnlQj5jG1BtVdZSdM_ZhndSlAoUv2CvYhw451SAl-xCULKSCjZs3B1wWtIBgzmeCjMmDLGwPpoUjM3B56nws8sWXTFjDsuUo82jCcV-XOytcVjYgyGU-nxM3sYPxXVxDEs8ok3-jsrLYQmpiCm702v2ojdjxDf35yX7_eXzr9238ubH1--765vS1qpO5d5A36keLbYcoFWd6Dh3Tescxb1ray4bgaCMBW6N3CO6BqAztcNGuAqqS_buPJce8idjTHry0eI4klxLjpo0Ekp0UFf_gTatrIWUitC3T9BhyWGmRbTgouZKVkIQ1ZwpSyLEgL0-Bj-ZcNLA9WqdHvSDdXq1bs2TddR4dT8-7yd0j20PXhHw6QwgSXfnMehoPc5kjQ8ktnaL__cdH5-MWClvzXiLJ4yP-4COQnP9c_1A6_-BpuJdJaD6C0KRw_E</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Zanjani, Amir Poya, MD</creator><creator>Maghsoudloo, Maziar, MD</creator><creator>Makarem, Jalil, MD</creator><creator>Farokhnia, Fahimeh, MD</creator><creator>Fazli, Morteza</creator><creator>Khan, Zahid Hussain, MD, FCCM</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>7QO</scope><scope>7U7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>P64</scope><orcidid>https://orcid.org/0000-0003-3911-2256</orcidid></search><sort><creationdate>20170201</creationdate><title>Chemotherapy alters cisatracurium induced neuromuscular blockade characteristics: A prospective cohort study</title><author>Zanjani, Amir Poya, MD ; Maghsoudloo, Maziar, MD ; Makarem, Jalil, MD ; Farokhnia, Fahimeh, MD ; Fazli, Morteza ; Khan, Zahid Hussain, MD, FCCM</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c484t-ba1f98fece70117892900d67dd701fd740562e18ac10ca5beed6119a4de62d313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Anesthesia & Perioperative Care</topic><topic>Anesthesia, General - methods</topic><topic>Antineoplastic Combined Chemotherapy Protocols - pharmacology</topic><topic>Atracurium - administration & dosage</topic><topic>Atracurium - analogs & derivatives</topic><topic>Atracurium - antagonists & inhibitors</topic><topic>Atracurium - pharmacology</topic><topic>Body temperature</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - surgery</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>Chemotherapy, Adjuvant</topic><topic>Cisatracurium</topic><topic>Cohort analysis</topic><topic>Cyclophosphamide - pharmacology</topic><topic>Doxorubicin</topic><topic>Doxorubicin - pharmacology</topic><topic>Drug Administration Schedule</topic><topic>Drug dosages</topic><topic>Electrolytes</topic><topic>Female</topic><topic>Fluorouracil - pharmacology</topic><topic>General anesthesia</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Intubation</topic><topic>Mastectomy</topic><topic>Metabolism</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative - methods</topic><topic>Neoadjuvant Therapy - methods</topic><topic>Neuromuscular Blockade - methods</topic><topic>Neuromuscular blocking agents</topic><topic>Neuromuscular Junction - drug effects</topic><topic>Neuromuscular Nondepolarizing Agents - administration & dosage</topic><topic>Neuromuscular Nondepolarizing Agents - antagonists & inhibitors</topic><topic>Neuromuscular Nondepolarizing Agents - pharmacology</topic><topic>Pain Medicine</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zanjani, Amir Poya, MD</creatorcontrib><creatorcontrib>Maghsoudloo, Maziar, MD</creatorcontrib><creatorcontrib>Makarem, Jalil, MD</creatorcontrib><creatorcontrib>Farokhnia, Fahimeh, MD</creatorcontrib><creatorcontrib>Fazli, Morteza</creatorcontrib><creatorcontrib>Khan, Zahid Hussain, MD, FCCM</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest - 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Design This is a non-randomized prospective cohort study. Setting Operating room of a university-affiliated teaching hospital. Patients Out of a total of 50 patients who had undergone mastectomy, 22 patients were allocated to the “Chemo group” and 28 patients to the “Non-Chemo group”, based on a valid history of recent chemotherapy. Intervention After induction of anesthesia with thiopental and cisatracurium, neuromuscular monitoring was started for all patients. Measurements Initially the time to 100% single-twitch (ST) suppression was measured. Then, the time for the appearance of the first response to post-tetanic count (PTC) stimulation, Train-of-Four (TOF) stimulation, and TOF50% were measured consequently. Main results Time to get STzero was significantly longer in the Chemo group than in the Non-chemo group. Time for the appearance of the first response of PTC and TOF and TOF50% was significantly shorter in the Chemo group than the other group. The mean duration of intense block was 27.66 minutes in the Chemo group versus 42.47 minutes in the Non-chemo group. Conclusion This research demonstrated that in patients having undergone chemotherapy, the effect of NDMRs starts with a longer lag time and finishes earlier too. Thus, these patients are ready for intubation after a longer time. Moreover, we have to repeat cisatracurium injections after shorter intervals to maintain the desired level of blockade.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28183581</pmid><doi>10.1016/j.jclinane.2016.10.025</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0003-3911-2256</orcidid></addata></record> |
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| subjects | Adult Anesthesia & Perioperative Care Anesthesia, General - methods Antineoplastic Combined Chemotherapy Protocols - pharmacology Atracurium - administration & dosage Atracurium - analogs & derivatives Atracurium - antagonists & inhibitors Atracurium - pharmacology Body temperature Breast cancer Breast Neoplasms - drug therapy Breast Neoplasms - surgery Cancer therapies Chemotherapy Chemotherapy, Adjuvant Cisatracurium Cohort analysis Cyclophosphamide - pharmacology Doxorubicin Doxorubicin - pharmacology Drug Administration Schedule Drug dosages Electrolytes Female Fluorouracil - pharmacology General anesthesia Humans Hypotheses Intubation Mastectomy Metabolism Middle Aged Monitoring, Intraoperative - methods Neoadjuvant Therapy - methods Neuromuscular Blockade - methods Neuromuscular blocking agents Neuromuscular Junction - drug effects Neuromuscular Nondepolarizing Agents - administration & dosage Neuromuscular Nondepolarizing Agents - antagonists & inhibitors Neuromuscular Nondepolarizing Agents - pharmacology Pain Medicine Prospective Studies |
| title | Chemotherapy alters cisatracurium induced neuromuscular blockade characteristics: A prospective cohort study |
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