Masui. The Japanese journal of anesthesiology
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We Japanese anesthesiologists can now use rocuronium as well as vecuronium. Although the onset of rocuronium is more rapid, the non-depolarizing neuromuscular blocking (NMB) agent has similar characteristics of duration and recovery compared to vecuronium. Reversal of NMB is therefore essential to recover patients safely. ⋯ Sugammadex is a novel and unique compound designed as an antagonist of rocuronium and possibly other steroid NMB agents. Sugammadex exerts its effect by forming very tight water-soluble complexes at a 1 : 1 ratio with steroid NMB agents (rocuronium>vecuronium>pancuronium). PhaseIII trials in Japan as well as Europe and the US have just been finished, and it is expected to be used clinically in the near future.
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Curare was clinically used in a patient with acute appendicitis by Griffith and Johnson in January 1942. From the day on, the development of new muscle relaxants went on in the world. ⋯ At present, pancuronium, vecuronium and rocuronium are routinely used in the world. In the future, we expect development of new muscle relaxants with rapid onset, intermediate duration of action, rapid recovery and without side effects.
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In the intensive care unit (ICU), neuromuscular blocking agent (NMBA) is occasionally used with sedatives and/or analgesics, for the management of mechanically-ventilated critically ill patients. For its application in ICU, close attention should be paid on the side effects unlikely seen during operation because the basal conditions of ICU patients are more serious and its infusion period is likely to be long. There have been reports of the prolonged weakness after the long term use of NMBA. ⋯ Strategy should be focused on its prevention. For example, routine monitoring with peripheral nerve stimulation and titration to the minimum dose of requirement, are relevant and effective. The application of NMBA in ICU is reviewed and rocuronium recently placed on market is within the scope of this article.
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A full stomach patient often requires a rapid sequence induction (RSI) technique to protect against gastric aspiration. Suxamethonium is the most common muscle relaxant used because it has a fast onset and a short duration. ⋯ However, it has been proved that suxamethonium creates superior intubation conditions to rocuronium in a large meta-analysis comparing intubation conditions. Once Org 25969 (sugammadex) is available to rapidly bind rocuronium and reverse its action, rocuronium may replace succinylcholine for rapid-sequence induction.
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How to titrate rocuronium under the specific conditions such as hepatic/renal failure, hypothermia, acidosis, and baby/aged, obese, with antibiotics, type of anesthetics, operation site and continuous infusion was discussed.