İlknur Suidiye YORULMAZ, Yavuz DEMİRARAN, Onur ÖZLÜ, Burhan DOST

The effect of vitamin D status on different neuromuscular blocker agents reverse time

Background/aim: This study is aimed to investigate the effects of vitamin D levels on sugammadex and neostigmine reversal times. Material and methods: Eighty patients between the ages of 18 and 65 years, with ASA I-III status who were undergoing surgery under general anesthesia were included in the study. A double blind fashion was used to randomly divide all the patients into two groups. At the end of the operation, sugammadex 2 mg/kg was administered to one group Group sugammadex and atropine and neostigmine was administered to the other group Group neostigmine intravenously. In the data analysis stage, the group was divided into two subgroups according to sugammadex and group neostigmine in itself, with vitamin D levels above and below 30 ng/mL. Statistical analysis was performed on these 4 groups Group neostigmine and vitamin D

Keywords:

Anesthesia, vitamin D muscle relaxation, sugammadex, neostigmine, neuromuscular blocker,

___

1. Marcinkowska E. A run for a membrane vitamin D receptor. Biological Signals Receptors 2001; 10(6): 341-349.
2. Nair VP, Hunter JM. Anticholinesterase and anticholinergic drugs. Continuing Education in Anaesthesia Critical Care & Pain 2004; 4: 164-168.
3. Naquib M, Lien CA. Pharmacology of muscle relaxants and their antagonists. In: Miller RD, Eriksson LI, Fleischer LA, Weiner-Kronish JP, Young WL (editors). Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2010. pp. 859-912.
4. Booij LH. Cyclodextrins and the emergence of sugammadex. Anaesthesia 2009; 64(1): 31-37.
5. Lien CA, Eikermann M. Neuromuscular blockers and reversal agents. In: Hemmings HC, Egan TD (editors). Pharmacology and Physiology for Anesthesia Foundations and Clinical Practice. Philadelphia: Elsevier Saunders; 2013. pp. 325-348.
6. Faul F, Erdfelder E, Lang A G, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods 2007; 39: 175-191.
7. Holick MF. Vitamin D status: measurement, interpretation and clinical application. Annals of epidemiology. 2009; 19(2): 73-78.
8. Massheimer V, Fernandez LM, Boland R, de Boland AR. Regulation of Ca +2 uptake by 1,25-diydroxyvitamin D3 : role of phosphorylation and calmoduline. Molecular and Cellular Endocrinology 1992; 84: 15-22.
9. De Roland AR, Boland RL. Non-genomic signal transduction pathway of vitamin D in muscle. Cellular Signalling 1994; 6: 717-724.
10. Bischoff HA, Stähelin HB, Dick W, Akos R, Knecht M et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. Journal of Bone and Mineral Research 2003; 18(2): 343-351.
11. Simpson RU, Thomas GA, Arnold AJ. Identification of 1,25-dihydroxyvitamin D3 receptors and activities in muscle. The Journal of Biological Chemistry 1985 Jul 25; 260(15): 8882-8891.
12. Bischoff HA, Borchers M, Gudat F, Duermueller U, Theiler R et al. In situ detection of 1,25-dihydroxyvitamin D3 receptor in human skeletal muscle tissue. The Histochemical Journal 2001; 33(1): 19-24.
13. Zerwekh J. Blood biomarkers of vitamin D status 1,2,3,4. The American Journal of Clinical Nutrition 2008; 87(4): 1087- 1091.
14. Schott GD, Wills MR. Muscle weakness in osteomalacia. Lancet 1976; 1: 626-629.
15. Miller RD, Van Nyhuis LS, Eger EI, Vitez TS, Way WI. Comperative times to peak effect and duration of action of neostigmine and pyridostigmine. Anesthesiology 1974; 41: 27- 33.
16. Hristovska AM, Duch P, Allingstrup M, Afshari A. The comparative efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. A Cochrane systematic review with meta-analysis and trial sequential analysis. Anaesthesia 2018; 73(5): 631–641.
17. Suy K, Morias K, Cammu G, Hans P, van Duijnhoven WG et al. Effective reversal of moderate rocuronium- or vecuroniuminduced neuromuscular block with sugammadex, a selective relaxant binding agent. Anesthesiology 2007; 106(2): 283-288.
18. Flockton EA, Mastronardi P, Hunter JM, Gomar C, Mirakhur RK et al. Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracuriuminduced block with neostigmine. British Journal of Anaesthesia 2008; 100(5): 622-630.
19. Ersoy Ö, Demiraran Y, Sezen G, Şeker İ S, Karagöz İ et al. Reversal Effects of Sugammadex in Diabetic Patients Having Neuromuscular Block with Rocuronium. Turkiye Klinikleri Journal of Medical Science 2015; 35(1): 36-42.
20. Prabhala A, Gary R, Dandona P. Severe myopathy associated with vitamin D deficiency in western New York. Archives of Internal Medicine 2000; 160: 1199-1203.
21. Ziambaras K, Dagogo-Jack S. Reversible muscle weakness in patients with vitamin D deficiency. The Western Journal of Medicine 1997; 167: 435-439.
22. Erden G, Ozdemir S, Ozturk G, Erden A, Kara D et al. Vitamin D levels of anesthesia personnel, office workers and outdoor workers in Ankara, Turkey. Clinical Laboratory 2016; 62(5): 931-937.