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Chemotherapy Alters Cisatracurium Induced Neuromuscular Blockade Characteristics: A Prospective Cohort Study Publisher Pubmed



Zanjani AP1 ; Maghsoudloo M1 ; Makarem J1 ; Farokhnia F2 ; Fazli M3 ; Khan ZH2
Authors
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Authors Affiliations
  1. 1. Tehran University of Medical Sciences, Assistant Professor, Dept. of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran
  2. 2. Tehran University of Medical Sciences, Professor, Dept. of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran
  3. 3. Tehran University of Medical Sciences, Dept. of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran

Source: Journal of Clinical Anesthesia Published:2017


Abstract

Study objective To compare the characteristics of NMDR induced muscle paralysis in breast cancer patients with and without a history of recent chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) regimen. Design This is a non-randomized prospective cohort study. Setting Operating room of a university-affiliated teaching hospital. Patients Out of a total of 50 patients who had undergone mastectomy, 22 patients were allocated to the “Chemo group” and 28 patients to the “Non-Chemo group”, based on a valid history of recent chemotherapy. Intervention After induction of anesthesia with thiopental and cisatracurium, neuromuscular monitoring was started for all patients. Measurements Initially the time to 100% single-twitch (ST) suppression was measured. Then, the time for the appearance of the first response to post-tetanic count (PTC) stimulation, Train-of-Four (TOF) stimulation, and TOF50% were measured consequently. Main results Time to get STzero was significantly longer in the Chemo group than in the Non-chemo group. Time for the appearance of the first response of PTC and TOF and TOF50% was significantly shorter in the Chemo group than the other group. The mean duration of intense block was 27.66 minutes in the Chemo group versus 42.47 minutes in the Non-chemo group. Conclusion This research demonstrated that in patients having undergone chemotherapy, the effect of NDMRs starts with a longer lag time and finishes earlier too. Thus, these patients are ready for intubation after a longer time. Moreover, we have to repeat cisatracurium injections after shorter intervals to maintain the desired level of blockade. © 2016 Elsevier Inc.