Perioperative titration habits of rocuronium in the young and elderly patient: A pharmacologic simulation-based survey comparing residents and licensed anesthesiologists

Keywords:

Neuromuscular block, Pharmacodynamics, Drug titration


Published online: May 17 2024

https://doi.org/10.56126/

F. Van Laere1, P. Tomassen2, A. Kalmar3,4, H. Vereecke4,5

1 Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
2 Department of Anesthesiology, University Hospitals Ghent, Ghent, Belgium
3 Department of Electronics and Information Systems, IBiTech, Ghent University, Ghent, Belgium
4 Department of Anesthesiology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
5 Department of anesthesiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands

Abstract

Objective and background: We explore the association between residents versus licensed anesthesiologist and the intention to adapt rocuronium titration to the patients’ age by simulating and comparing the effect-site concentrations of rocuronium (CeROC) and a model derived train of four percentage (TOF%) within and between study groups. The estimation of TOF% by responders is compared with a model derived TOF% and with the intention to use rocuronium antagonists.

Methods: A survey in four Belgian hospitals inquired for intended rocuronium dosages of residents and anesthesiologists when managing a laparoscopic procedure in identical ASA1 patients, apart from their age (being respectively 18 versus 80 years). Smart Pilot View® simulator (SPV, Draeger, Lübeck, Germany) calculates the corresponding CeROC and TOF% at several time points and at the end of surgery.

Results: 87 residents and anesthesiologists responded (= 30% response rate). Compared to licensed anesthesiologists, residents make larger dose adjustments for young versus elderly patients. Residents intubate young patients faster but postpone the intubation in elderly to a similar intubation time as anesthesiologists. Both responder groups estimate TOF% at the end of surgery with wide variation while the model derived TOF% was 100% in all patients. In young patients, respectively 13% and 19% of residents and anesthesiologists do not intend to reverse the rocuronium effect despite expecting a TOF%<90%.

Conclusions: Residents intubate young patients (but not elderly) faster compared to anesthesiologists. At induction, both residents and anesthesiologists make age-dependent dose adjustments for rocuronium but make suboptimal reversal decisions when estimating TOF% based on drug administration history only.

ActaAnaesthBelg-74-s1-Cover

About this issue

Volume 74, supplement 1.

Dec 2023.

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