Neuromuscular Block in Patients 80 Years and Older

A Prospective, Controlled Study

Denis Schmartz; Raouf Sghaier; Paul Bernard; Jean Francois Fils; Thomas Fuchs-Buder

Disclosures

BMC Anesthesiol. 2021;21(225) 

In This Article

Abstract and Introduction

Abstract

Background: An increasing number of patients older than 80 years are undergoing anesthesia, but little information is available regarding pharmacodynamic effects of myorelaxants in this population. This study aims to compare the time course of rocuronium neuromuscular block in patients ≥ 80 years with those of younger adults.

Methods: Under total intravenous anesthesia with propofol and sufentanil, time course of a bolus of rocuronium 0.6 mg/kg neuromuscular block was assessed with acceleromyography in patients ≥ 80 and in patients 20–50 years old. Onset time, clinical duration, duration until 90% and 100% recovery of baseline were determined.

Results: Data from 32 patients were analyzed, 16 were ≥ 80 years and 16 were 20–50 years old. Demographic data are shown in Table 1. In the group ≥ 80, onset time was 190 s ± 46 s compared to 123 s ± 40 s in the group 20–50, P < 0.001 and the clinical duration was 52 [48–69.5] min and 36 [34–41] min, respectively, P < 0.001. Duration to 90% recovery of baseline was 77.5 [71–88.5] min and duration to 100% recovery of baseline was 91.2 [82.2–98] min in patients ≥ 80 years and the corresponding values in the patients 20–50 years old were 53.5 [49–55.5] min and 59.5 [56.5–70.25] min, respectively, P < 0.001.

Conclusion: Compared to younger adults rocuronium shifted in patients ≥ 80 years from a rapid onset, intermediate acting compound to a slower onset, long-acting compound.

Trial registration: ClinicalTrials.gov identifier: NCT03551652 (29/05/2018).

Introduction

Neuromuscular blocking agents (NMBA) are used to facilitate tracheal intubation and improve surgical conditions.[1–3] Residual neuromuscular blockade is commonly seen postoperatively and patients with residual paralysis have an increased risk of postoperative respiratory complications such as hypoxemia and upper airway obstruction.[4–6] The risk of residual paralysis and respiratory complications is markedly increased among elderly patients.[7,8] The presence of small degrees of muscle weakness after tracheal extubation may significantly affect outcome in this patient population, as the elderly have limited physiologic reserve.[9] In particular, pharyngeal function and muscle strength may be impaired in patients older than 65 years, and the residual effects of NMBA's may further worsen this impairment.[8,10] Approximatively 50% of elderly patients will require anesthesia for surgical interventions and increasing age may be associated with greater morbidity and mortality after anesthesia.[11,12] According to Eurostat's 2019 edition of Ageing Europe report, the oldest old (i.e. patients ≥ 80 years) are within the group of elderly the fastest growing segment of the population at large. Unfortunately, pharmacodynamic data of NMBA in patients ≥ 80 years old are sparse.

The aim of this prospective, controlled observational study was to compare the time course of neuromuscular blockade after rocuronium 0.6 mg/kg in patients ≥ 80 years old with patients between 20–50 years. We hypothesized that patients ≥ 80 years old have slower onset and increased duration and recovery of neuromuscular blockade.

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