Type II Diabetes Mellitus Prolongs Rocuronium Induced Neuromuscular Blockade Irrespective of Glycaemic Control

Objective: Recovery from neuromuscular blockade could be delayed and the risk of postoperative residual neuromuscular blockade could be an important anesthetic consideration in diabetic patients undergoing general anesthesia due to decreased nerve conduction velocity. The aim of this study was to analyse the recovery from ro- curonium and the risk of postoperative residual neuromuscular blockade in type-II diabetic patients undergoing general anesthesia with sevoflurane. Materials and Methods: The patients undergoing general anesthesia with sevoflurane and rocuronium for abdominal surgery were included in this prospective observa- tional study between December 2014 - May 2015. After rocuronium injection; time to reappearance of T1, T2, T3 and T4 and time to reaching train of four ratios of 0.7 and 0.9 were recorded. For detecting residual neuromuscular blockade, train of four ratios were recorded in the postoperative care unit at 5 th and 10 th minutes of arrival. The correlation between glycemic control and the risk of residual neuromuscular block- ade was also evaluated via glycosylated haemoglobin (HbA1c) levels. Results: A total of 82 patients (Group diabetes mellitus: 48 patients, Group non-dia- betes mellitus: 34 patients) were included. The groups were comparable according to demographic data and other characteristics that can effect neuromuscular blockade. Times to reappearance of T1, T2, T3, T4 and to reaching a train of four ratio of 0.9 were significantly longer in Group diabetes mellitus. Although there was no differ- ence between the train of four ratios at the arrival to the postoperative care unit, train of four ratios of Group diabetes mellitus were significantly lower at 5 th and 10 th min- utes at postoperative care unit. Poor glycaemic control was found not to affect the risk of residual neuromuscular blockade. Conclusion: Even in the absence of known neurologic complications; the neuromus- cular blockade effect of rocuronium is longer and the risk of residual neuromuscular blockade is higher in type-II diabetic patients irrespective of the degree of glycaemic control.

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