MUSTAFA AZİZOĞLU, Gökhan Berktuğ BAHADIR, ALİ NAYCI, HANDAN BİRBİÇER, Gülhan TEMEL OREKİCİ

PED

Amaç: Pediatrik hastalarda süksinilkolin kullanımı hiperkalemi ve malign hipertermi gibi yan etkileri nedeniyle çekinceyaratmaktadır. Son yıllarda erişkin hastalarda roküronyum ve sugammadeks, hem kas gevşetici kullanımının gerektiği kısa surelivakalarda hem de hızlı seri entübasyonda süksinilkoline alternatif olarak kullanılmaktadır. Buna rağmen pediatrik hastalardaroküronyum ve sugammadeks kullanımı ile ilgili veriler kısıtlıdır. Yöntem: Bu retrospektif çalışmada, pediatrik kısa süreli cerrahi prosedürlerde süksinilkolin ile roküronyum ve sugammadeksinblok süresi karşılaştırılmıştır. 2014-2016 yılları arasında rijid bronkoskopi ve özefagoskopi uygulanmış olan 50 hastanın anestezikayıtları retrospektif olarak incelenmiştir. Sonuçlar: İki grup karşılaştırıldığında süksinilkolin kullanılan hastalarda T90, T100 ve ekstübasyon süresi anlamlı olarak kısaölçülmesine rağmen cerrahi prosedürün tamamlanması sonrasında kas gevşeticilerin etkisinin ortadan kalkması için geçen süredeğrlendirildiğinde anlamlı fark bulunmadı. Roküronyum sugammadeks grubunda TOF değerinin %90'a ulaşılması için geçensüre ortalama 1.52±0.60 dakika idi.Sonuç: Cerrahinin bitiş zamanı dikkate alındığında her iki grupta kas gevşeticilerin etki sonlanma süreleri arasında farkbulunmadı. Buna rağmen, görülen yan etkiler dikkate alındığında roküronyum sugammadeks kullanımının süksinilkolin kullanımındandaha güvenli olabileceği düşünüldü.

COMPARISON OF NEUROMUSCULAR MONITORING MEASUREMENTS WITH ROCURONIUM-SUGAMMADEX AND SUCCINYLCHOLINE IN PEDIATRIC SHORT PROCEDURES: A RETROSPECTIVE STUDY

Objective: The use of succinylcholine is not encouraged for pediatric patients due to possible life-threatening side effects suchas hyperkalemia and malignant hyperthermia. In recent years, rocuronium-sugammadex has been used in adult patients as analternative to succinylcholine both in short procedures requiring muscle relaxant and in rapid serial intubation. However, data onthe use of rocuronium and sugammadex in pediatric patients are limited. In this retrospective study, we compared neuromuscularblockade duration between succinylcholine and rocuronium reversed with sugammadex in pediatric short procedures. Method: The anesthesia records of 50 patients who underwent rigid bronchoscopy and esophagoscopy with neuromuscularmonitoring between 2014 and 2016 years were reviewed retrospectively. Results: There was no significant difference between two agents in terms of the muscle relaxant reversing time after the end ofthe procedure, although there were significant differences in terms of time to T90, T100 and extubation time. Mean time to a train-offour ratio of 0.9 was 1.52±0.60 min for rocuronium-sugammadex. Conclusion: There is no significant difference between the two agents in terms of post-procedure muscle relaxant reversal time.However, considering the rates of side effects observed, the use of rocuronium-sugammadex may be eligible than succinylcholine.

PDF

___

1. Zur KB, Ritman RS. Pediatric airway foreign body retrieval: surgical and anesthetic perspectives. Pediatric Anesthesia 2009; 19: 109-117.
2. Daines CL, Wood RE, Boesch RP. Foreign body aspiration: an important etiology of respiratory symptoms in children. J Allergy Clin Immunol 2008; 121: 1297-1298.
3. Farrel PT. Rigid bronchoscopy for foreign body removal: anaesthesia and ventilation. Pediatric Anesthesia 2004; 14: 84-89.
4. Shen X, Hu CB, Ye M, Chen YZ. Propofol-remifentanil intravenous anesthesia and spontaneous ventilation for airway foreign body removal in children with preoperative respiratory impairment. Pediatric Anesthesia 2012; 22: 1166-1170.
5. Karanovic N, Carev M, Kardum G, et al. Succinylcholine use in adult anesthesia - A multinational questionnaire survey. Coll Antropol 2011; 35(Suppl 1): 183-190.
6. Koksal E, Ustun YB, Kaya C, Sahin AR, Sahinoglu AH. Comparing the effects of rocuronium-sugammadex and succinylcholine on recovery during electroconvulsive therapy. Anatolian Journal of Psychiatry 2015; 16: 198-204.
7. Cook DR, Fischer CG. Neuromuscular blocking effects of succinylcholine in infants and children. Anesthesiology 1975; 42: 662-665.
8. Plaud B, Meretoja O, Hofmockel R et al. Reversal of rocuronium induced neuromuscular blockade with sugammadex in pediatric and adult surgical patients. Anesthesiology 2009; 110: 284-294.
9. Kara T, Ozbagriacik O, Turk HS et al. Sugammadex versus neostigmine in pediatric patients: a prospective randomized study. Rev Bras Anestesiaol 2014; 64: 400-405.
10. Taha SK, El-Khatib MF, Baraka AS, Haidar YA, Abdallah FW, Zbeidy RA, Siddik-Sayid SM. Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction. Anesthesia 2010; 65: 358-361.
11. Peeters PA, van den Heuvel MW, van Heumen E, et al. Safety, tolerability and pharmacokinetics of sugammadex using single high doses (up to 96 mg kg-1) in healthy adult subjects: a randomized, double-blind, crossover, placebo controlled, single-centre study. Clin Drug Investig 2010; 30: 867-874.
12. Durant NN, Katz RL. Suxamethonium. Br J Anaest 1982; 54: 195-208.
13. Bhananker SM, Ramamoorthy C, Geiduschek JM et al. Anesthesiarelated cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry. Anesth Analg 2007; 105: 344-350.
14. Gronert GA. Cardiac arrest after succynilcholine: Mortality greather with rabdomyolysis than receptor upregulation. Anesthesiology 2001; 94: 523-529.
15. Sorgenfrei IF, Norrild K, Larsen PB, et al. Reversal of rocuroniuminduced neuromuscular block by the selective relaxant binding agent sugammadex: a dose-finding and safety study. Anesthesiology 2006; 104: 667-674.
16. Shields M, Giovannelli M, Mirakhur RK, Moppett I, Adams J, Hermens Y. Org 25969 (sugammadex), a selective relaxant binding agent for antagonism of prolonged rocuronium-induced neuromuscular block. Br J Anaesth 2006; 96: 36-43.
17. Cammu G, De Kam PJ, Demeyer I, et al. Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers. Br J Anaesth 2008; 100: 373-379.
18. Soodan A, Pawar D, Subramanium R. Anesthesia for removal of inhaled foreign bodies in children. Paediatr Anaesth 2004; 14: 947-952.