A Practical Dosing Algorithm for Deep Neuromuscular Blockade during Total Intravenous Anesthesia: ROCURITHM
Authors' conclusion
This study proposes a dosing algorithm for deep NMB with rocuronium in patients receiving total intravenous anesthesia.
Study context
- Population
- Patients undergoing laparoscopic surgery with TIVA and deep neuromuscular blockade (NMB) (PTC 1 to 2)
- Participants
- 424 patients · 3 pooled trials
- Comparison
- Algorithm vs No algorithm
- Algorithmn = 32
- No algorithmn = 180reference
- Outcome
- Proportion of 5-min measurements on target PTC 1 to 2 throughout surgery
Methodological detailsvalidation cohort, comparison with ongoing studies without the algorithm
- Validation cohort
- Comparison with ongoing studies without the algorithm
Pooled result
As reported in the abstract
5-min measurements on target PTC 1 to 2
Algorithm
76%
mean
Algorithm vs Residents without algorithmCohen's d (95% CI)P value
Residents after 0 to 20 patients: 42% on target
1.4(0.9–1.8)
P ≤ 0.001Residents after 81 to 100 patients: 61% on target
0.7(0.1–1.2)
P ≤ 0.05Further pooled results
Rocuronium dose for PTC 1 to 2 (actual bodyweight, pooled trials)
- Mean ± SD rocuronium dose, mg · kg-1 ·h-1
- 1.0 ± 0.27
- Mean duration of surgery, min
- 116
Induction dose 0.6 mg ·kg-1
- PTC 1 to 5 reached in a quarter of patients after mean 11 min; remainder equally too shallow or too deep
Original publication
A Practical Dosing Algorithm for Deep Neuromuscular Blockade during Total Intravenous Anesthesia: ROCURITHM. Anesthesiology. Published 10 May 2024. doi:10.
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