Open Access Open Access  Restricted Access Subscription Access

Onset and duration of intravenous and intraosseous rocuronium in hypovolemic swine

Miguel Nemeth, MSN, George N. Williams III, CRNA, MSN, Debbie Prichard, CRNA, MSN, Angie McConnico, BSN, Don Johnson, PhD, Michael Loughren, CRNA, PhD

Abstract


 Objective: Compare the onset and duration of rocuronium administered via the intravenous (IV), and intraosseous (IO) routes in a hypovolemic swine model.

Design: Prospective, between subjects, experimental study.

Setting: Vivarium.

Subjects: Yorkshire-cross swine (N = 8).

Intervention: Electromyography (EMG) amplitudes were recorded at baseline and for every 15 seconds after administering 1.2 mg/kg of rocuronium via IV or IO routes to hypovolemic swine. EMG amplitudes were measured until termination of EMG activity and then measured every 5 minutes until there was a return to baseline values. Individual data were transformed to percent baseline.

Main Outcome Measurements: The time from the end of injection to 90 percent reduction of baseline EMG activity (Onset90), the time to maximum reduction (Onsetpeak), and the maximum reduction of the neuromuscular response (peak effect), as well as, time from the end of injection to the return of 25, 50, 75, and 95 percent of baseline EMG activity was used to characterize onset and recovery of neuromuscular function.

Results: Maximum reduction, Onset 90 and Onset peak times were not statistically different between groups. The IV group's mean time to recovery of all benchmarks was faster than the IO group. The IO group took statistically longer than the IV group to return to 25, 50, 75, and 95 percent of baseline activity.

Conclusion: The IO route is an effective method of administering rocuronium and is comparable to the IV route even under conditions of significant hemorrhage.


Keywords


intraosseous, rocuronium, pharmacokinetics, hypovolemia, hemorrhage, trauma

Full Text:

PDF

References


Levitan RM, Bortle CD, Snyder TA, et al.: Use of a battery-operated needle driver for intraosseous access by novice users: Skill acquisition with cadavers. Ann Emerg Med. 2009; 54(5): 692-694.

Brenner T, Bernard M, Helm M, et al.: Comparison of two intraosseous infusion systems for adult emergency medical use. Resuscitation. 2008; 78(3): 314-319.

Anson JA, Sinz EH, Swick JT: The versatility of intraosseous vascular access in perioperative medicine: A case series. J Clin Anesthesia. 2015; 27(1): 63-67.

Loughren M, Banks S, Naluan C, et al.: Onset and duration of intravenous and intraosseous rocuronium in swine. W J Emerg Med. 2014; 15(2): 241-245.

Voelckel WG, Lurie KG, McKnite S, et al.: Comparison of epinephrine with vasopressin on bone marrow blood flow in an animal model of hypovolemic shock and cardiac arrest. Crit Care Med. 2001; 29(8): 1587-1592.

Martini WZ, Cortez DS, Dubick MA, et al.: Thromboelastography is better than PT, aPTT, and activated clotting time in detecting clinically relevant clotting abnormalities after hypothermia, hemorrhagic shock and resuscitation in pigs. J Trauma. 2008; 65(3): 535-543.

Hemmerling TM, Schurr C, Walter S, et al.: A new method of monitoring the effect of muscle relaxants on laryngeal muscles using surface laryngeal electromyography. Anesth Analg. 2000; 90(2): 494-497.

Goldberg ME, Larijani GE, Azad SS, et al.: Comparison of tracheal intubating conditions and neuromuscular blocking profiles after intubating doses of mivacurium chloride or succinylcholine in surgical outpatients. Anesth Analg. 1989; 69(1): 93-99.

Anson JA: Vascular access in resuscitation: Is there a role for the intraosseous route. Anesthesiology. 2014; 120(4): 1015-1031.

Blebea JS, Houseni M, Torigian DA, et al.: Structural and functional imaging of normal bone marrow and evaluation of its age related changes. Semin Nucl Med. 2007; 37(3): 185-194.

Yost J, Baldwin P, Bellenger S, et al: The pharmacokinetics of intraosseous atropine in hypovolemic swine. Am J Disaster Med. 2015; 10(3): 217-222.

Strandberg G, Larsson A, Lipcsey M, et al.: Intraosseous and intravenous administration of antibiotics yields comparable plasma concentrations during experimental septic shock. Acta Anaesthesiol Scand. 2015: 59(3): 346-353.




DOI: http://dx.doi.org/10.5055/ajdm.2016.0250

Refbacks

  • There are currently no refbacks.