Skip to main content
SpringerLink
Log in

Plasma rocuronium concentration in cell salvage blood following cardiac surgery: a case series

  • Brief Report
  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Purpose

The aim of the study was to evaluate the plasma rocuronium concentration in autologous blood transfusion obtained from the cell salvage (CS) system following cardiac surgery with cardiopulmonary bypass (CPB).

Methods

This prospective observational study was conducted in a university teaching hospital from July to November 2020. Patients undergoing general anesthesia for cardiac surgery with CPB were enrolled in the study. After separation from CPB, residual blood remaining in the extracorporeal system was collected as the control sample. The second sample (CS blood) was collected from the autologous blood transfusion obtained after completion of the CS system with Cell Saver® Elite®. Hematocrit values of both samples were also examined.

Results

Ten subjects (aged 57–86 years) were enrolled in this study. Plasma rocuronium concentrations (ng/ml) were significantly lower in the CS blood (94.0 ± 77.5) compared to the control (2950 ± 812.2) (p = 0.002). Hematocrit values (%) were significantly higher in the CS blood (75.2 ± 11.3) compared to the control (40.2 ± 10.2) (p = 0.002).

Conclusion

Autologous blood transfusion obtained from CS system following cardiac surgery with CPB, only retained a small amount of plasma rocuronium concentration, therefore, the risk of autologous blood transfusion contributing to clinically relevant residual neuromuscular blockade postoperatively should be considered to be low.

Trial registration

This trial was registered in the University Hospital Medical Information Network under registration number UMIN000040877 (registration date; June 24, 2020).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on request.

References

  1. Neirotti RA, Jones D, Hackbarth R, Paxson Fosse G. Early extubation in congenital heart surgery. Heart Lung Circ. 2002;11(3):157–61. https://doi.org/10.1046/j.1444-2892.2002.00144.x.

    Article  PubMed  Google Scholar 

  2. McEwin L, Merrick PM, Bevan DR. Residual neuromuscular blockade after cardiac surgery: pancuronium vs rocuronium. Can J Anaesth. 1997;44(8):891–5. https://doi.org/10.1007/bf03013167.

    Article  CAS  PubMed  Google Scholar 

  3. Van Oldenbeek C, Knowles P, Harper NJ. Residual neuromuscular block caused by pancuronium after cardiac surgery. Br J Anaesth. 1999;83(2):338–9. https://doi.org/10.1093/bja/83.2.338.

    Article  PubMed  Google Scholar 

  4. Murphy GS, Szokol JW, Marymont JH, Avram MJ, Vender JS, Rosengart TK. Impact of shorter-acting neuromuscular blocking agents on fast-track recovery of the cardiac surgical patient. Anesthesiology. 2002;96(3):600–6. https://doi.org/10.1097/00000542-200203000-00015.

    Article  CAS  PubMed  Google Scholar 

  5. Cammu G, Neyens E, Coddens J, Van Praet F, De Decker K. Postoperative residual curarisation is still an issue when weaning patients in intensive care following cardiac surgery. Anaesth Intensive Care. 2018;46(6):634–6.

    CAS  PubMed  Google Scholar 

  6. Murphy GS, Szokol JW, Vender JS, Marymont JH, Avram MJ. The use of neuromuscular blocking drugs in adult cardiac surgery: results of a national postal survey. Anesth Analg. 2002;95(6):1534–9. https://doi.org/10.1097/00000539-200212000-00012.

    Article  PubMed  Google Scholar 

  7. Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, Song HK, Clough ER, Shore-Lesserson LJ, Goodnough LT, Mazer CD, Shander A, Stafford-Smith M, Waters J, Baker RA, Dickinson TA, FitzGerald DJ, Likosky DS, Shann KG. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg. 2011;91(3):944–82. https://doi.org/10.1016/j.athoracsur.2010.11.078.

    Article  PubMed  Google Scholar 

  8. Vonk AB, Meesters MI, Garnier RP, Romijn JW, van Barneveld LJ, Heymans MW, Jansen EK, Boer C. Intraoperative cell salvage is associated with reduced postoperative blood loss and transfusion requirements in cardiac surgery: a cohort study. Transfusion. 2013;53(11):2782–9. https://doi.org/10.1111/trf.12126.

    Article  PubMed  Google Scholar 

  9. Vieira SD, da Cunha Vieira Perini F, de Sousa LCB, Buffolo E, Chaccur P, Arrais M, Jatene FB. Autologous blood salvage in cardiac surgery: clinical evaluation, efficacy and levels of residual heparin. Hematol Transfus Cell Ther. 2019. https://doi.org/10.1016/j.htct.2019.08.005.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Frank SM, Sikorski RA, Konig G, Tsilimigras DI, Hartmann J, Popovsky MA, Pawlik TM, Waters JH. Clinical utility of autologous salvaged blood: a review. J Gastrointest Surg. 2020;24(2):464–72. https://doi.org/10.1007/s11605-019-04374-y.

    Article  PubMed  Google Scholar 

  11. Rohling RG, Rentsch KM, Beck-Schimmer B, Fuchs-Buder T. Risk of recurarization during retransfusion of autologous blood withdrawn after injection of muscle relaxants: a comparison of rocuronium and mivacurium. J Clin Anesth. 2003;15(2):85–90. https://doi.org/10.1016/s0952-8180(02)00519-6.

    Article  CAS  PubMed  Google Scholar 

  12. Heier T, Caldwell JE, Eriksson LI, Sessler DI, Miller RD. The effect of hypothermia on adductor pollicis twitch tension during continuous infusion of vecuronium in isoflurane-anesthetized humans. Anesth Analg. 1994;78(2):312–7. https://doi.org/10.1213/00000539-199402000-00019.

    Article  CAS  PubMed  Google Scholar 

  13. Eriksson LI, Lennmarken C, Jensen E, Viby-Mogensen J. Twitch tension and train-of-four ratio during prolonged neuromuscular monitoring at different peripheral temperatures. Acta Anaesthesiol Scand. 1991;35(3):247–52. https://doi.org/10.1111/j.1399-6576.1991.tb03282.x.

    Article  CAS  PubMed  Google Scholar 

  14. Cammu G, Coddens J, Hendrickx J, Deloof T. Dose requirements of infusions of cisatracurium or rocuronium during hypothermic cardiopulmonary bypass. Br J Anaesth. 2000;84(5):587–90. https://doi.org/10.1093/bja/84.5.587.

    Article  CAS  PubMed  Google Scholar 

  15. Cammu G, de Baerdemaeker L, den Blauwen N, de Mey JC, Struys M, Mortier E. Postoperative residual curarization with cisatracurium and rocuronium infusions. Eur J Anaesthesiol. 2002;19(2):129–34. https://doi.org/10.1017/s0265021502000236.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We express our appreciation to Dr. Kazuhiro Watanabe, Research Institute of Medical Research Support Center, Nihon University School of Medicine, Japan, for the plasma rocuronium concentration assay.

Funding

This study has not received any funding.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan

    Hajime Iwasaki, Shunichi Takagi, Osamu Kitajima, Yukino Oshima & Takahiro Suzuki

  2. Department of Anesthesia, Indiana University School of Medicine, 1130 W. Michigan St, Fesler Hall 204, Indianapolis, IN, 46202, USA

    Sarah Kyuragi Luthe

Authors
  1. Hajime Iwasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shunichi Takagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osamu Kitajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yukino Oshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarah Kyuragi Luthe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takahiro Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study design: HI. Advisor for study protocol: SKL and TS. Data collection: HI, ST, OK, and YO. Data analysis: HI. Manuscript preparation: HI, ST, OK, YO, and SKL. Editing and approval of the manuscript: TS. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Hajime Iwasaki.

Ethics declarations

Conflict of interest

Hajime Iwasaki, Shunichi Takagi, Osamu Kitajima, and Takahiro Suzuki have received speaker fees from MSD. Inc, Japan. Yukino Oshima and Sarah Kyuragi Luthe have no conflict of interest.

Ethical approval

The study was approved by the Nihon university Itabashi hospital ethics committee (approval number: RK-200609–5).

Informed Consent

Written informed consent was obtained from all the participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iwasaki, H., Takagi, S., Kitajima, O. et al. Plasma rocuronium concentration in cell salvage blood following cardiac surgery: a case series. J Clin Monit Comput 36, 1213–1217 (2022). https://doi.org/10.1007/s10877-021-00755-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-021-00755-4

Keywords

Search

Navigation