D Vitamin Effects on Neuromuscular Blocker Reverse Time
Condition: Vitamin D Deficiency; Neuromuscular Block; Neuromuscular Block Problem
MeSH terms: Vitamin D Deficiency
Study type: Observational [Patient Registry]

Summary: 
      Background/aim: Investigators aimed to investigate the effect of D vitamin levels on
      Sugammadex and Neostigmine reverse durations in the study.

      Materials and methods: Eighty patients between 18 and 65 years, with ASA I-III status who
      were undergoing surgery under general anaesthesia were included the study. All patients were
      randomly divided into two groups with double blindness and 1.25 (OH) 2 vitamin D, 25 (OH) 2
      vitamin D, and calcium levels were measured. At the end of the operation, 2 mg/kg of
      Sugammadex was administered to one group and Atropine + Neostigmine to the other group. The
      patients were also divided into two groups as to whether their vitamin D levels were ≥ 30
      ng/mL or below.

      A train of four values was recorded after a hypnotic agent was given at the beginning and
      throughout the operation. The time to complete the disappearance of response to TOF
      stimulation was recorded as T0.

      End of the operation: When 2 responses to TOF stimulation were taken, the following times
      were recorded until the extubation phase by administering at least 2 mg/kg of Sugammadex or
      0.05 mg/kg of Neostigmine 0.05 mg/kg of Atropine per kg of body weight. The time until the
      TOF value reached 50,70,90% and extubation were recorded.
    

Detailed description: 
      Prospective observational study was carried out in the same centre after the approval of the
      University Hospital by the ethical committee of non-invasive research (Duzce University,
      School of Medicine, Ethics Committee of Non-invasive clinical research approval for
      application Date: 11.10.2013, Decision Number: 2013/439) and done by Anaesthesiology
      Department in the same centre. This research was also funded by our University Scientific
      Research Project Coordinating Department (2014.04.02.221).

      Eighty-four patients with ASA I-III status, undergoing surgery under general anaesthesia
      between the ages of 18 and 65 years were included the study. Twenty millilitre blood samples
      were taken from the antecubital ven before the operation, after taken the approval of all
      patients. 1.25 (OH) 2 vitamin D, 25 (OH) 2 vitamin D, calcium, magnesium, phosphorus and
      parathormone levels were measured in the blood samples. All patients were randomly divided
      into two groups with double blindness. At the end of the operation, a 2 mg/kg dose of
      Sugammadex (Group Sugammadex n = 40) and 0.55 mg/kg + 0.015 mg/kg atropine Neostigmine (to
      the other group) were administered intravenously. The patients were also divided into two
      groups, having vitamin D levels above 30 ng/mL and below 30 ng/mL.

      All patients were connected to a kinemyograph, which placed the neuromuscular transmission
      (NMT) module (GE Health Care) on the patients' adductor pollicis muscle before the
      anaesthesia induction. Patients body temperature were monitored and maintained within 35-37 0
      C. Subsequently, the hypnotic agent was given at the beginning of the operation and Train of
      Four (TOF) values were recorded as % values throughout the operation. All patients received 2
      mg of Midazolam intravenously for premedication. All patients were monitored by standard
      monitoring and received 2 mg / kg Propofol and 1 mcg/kg Fentanyl. Train of Four (TOF)
      stimulation started at 1 Hz intervals at a frequency of 2 Hz in 1-minute intervals. The
      initial values determined were recorded as the baseline TOF values and 0.5 mg / kg Rocuronium
      (Esmeron amp, Organon, Holland) was administered intravenously, which was calculated on ideal
      body weight. The time to complete disappearance of response to TOF stimulation was recorded
      as T0 and endotracheal intubation was performed.

      Anaesthetic maintenance was proven by 50% oxygen + 50% air + 2% volume Sevoflurane via
      endotracheal tube. Remifentanil was administered intravenously at 0.05-1 mcgr /kg /h. When a
      2-point response to TOF was received, the muscle relaxant was administered in repeated doses
      as 10 mg of Rocuronium.

      The total muscle relaxant quantities were recorded. At the end of the operation: when 2
      responses to TOF stimulation were taken, the following times were recorded until the
      extubation phase by administering at least 2 mg/kg of Sugammadex (Bridion flk, Merck Sharp &
      Dohme) or 0.05 mg/kg of Neostigmine (Neostigmin amp, Adeka, Turkey) and 0.05 mg/kg of
      Atropine per kg body weight.

      T0.5: The time until the TOF value reached 50% T0.7: The time until the TOF value reached 70%
      T0.9: The time until the TOF value reached 90% Teks: Time to extubation.

      Patients, who were able to open their eyes with spontaneous breathing, had a tidal volume of
      10 ml/kg, according to ideal body weight during spontaneous breathing, pulse oximetry values
      above 95%, headache for 5 seconds, and TOF values above 90%.

      Statistical analysis

      Investigators used the independent samples t-test for two variables, continuous variables for
      comparison, and the Pearson Chi-square test for categorical variables. Repeated measures
      ANOVA was used to examine the interaction between drug groups and TOF measurement time.
      Co-effects of drug groups and vitamin D subgroups were examined by two-way analysis of
      variance (ANOVA). Repeated measures ANOVA, one of the three-factor differentials, were used
      to examine the TOF measurement time interaction of drug effects and vitamin D subgroups'
      concerted effects. Statistical analyses were performed with the SPSS v.22 packet program and
      the significance level was taken as 0.05.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Eighty four patients with ASA I-III status undergoing surgery under general anesthesia
        between the ages of 18 and 65 years were included the study
      
Biospecimen description: 
      Venous blood samples 20 ml
    
Keywords: Sugammadex; Neostigmine; Anesthesia; Neuromuscular blockers; Reverse time; Vitamin D