{"id":115586,"date":"2014-02-05T00:00:00","date_gmt":"2014-02-05T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/eficacia-de-sugammadex-en-la-reversion-profunda-del-bloqueo-neuromuscular-inducido-por-rocuronio-en-pacientes-con-enfermedad-renal-terminal-sometidos-a-trasplante-renal\/"},"modified":"2014-02-05T00:00:00","modified_gmt":"2014-02-05T00:00:00","slug":"eficacia-de-sugammadex-en-la-reversion-profunda-del-bloqueo-neuromuscular-inducido-por-rocuronio-en-pacientes-con-enfermedad-renal-terminal-sometidos-a-trasplante-renal","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/cirugia-de-trasplantes\/eficacia-de-sugammadex-en-la-reversion-profunda-del-bloqueo-neuromuscular-inducido-por-rocuronio-en-pacientes-con-enfermedad-renal-terminal-sometidos-a-trasplante-renal\/","title":{"rendered":"Eficacia de sugammadex en la reversi\u00f3n profunda del bloqueo neuromuscular inducido por rocuronio en pacientes con enfermedad renal terminal sometidos a trasplante renal"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Natalia Navarro Garcia <\/strong><\/h2>\n<p>Key words:  sugammadex. Reversal profound neuromuscular blockade. renal transplantation. End stage renal disease. Antagonism.  safety neuromuscular function recovery.  Acceleromyography. qt interval evaluation.   efficacy of sugammadex reversal profound rocuronium-induced neuromuscular blockade in patients with end stage renal disease in surgery for renal transplantation.  sugammadex antagonizes rocuronium-induced neuromuscular blockade (nmb) by encapsulating the molecules of rocuronium in plasma and originating a complex which is mainly excreted by kidneys. The aim was to compare the efficacy and safety of sugammadex in the reversal of profound nmb after surgery for renal transplantation in patients with end stage renal disease (esrd) and compare it with normal renal function patients.  multicenter, prospective, randomized, parallel group study with competitive recruitment. Twenty patients with esrd scheduled for kidney transplantation from cadaver donors (tg) and twenty controls (cg) were enrolled.  anesthesia: propofol tci, remifentanyl, rocuronium to maintain deep level of nmb (ptc &lt; 3) during all procedure as measured by acceleromyograph (tof watch). Sugammadex 4 mg\/kg when the skin suture was finished.   primary efficacy variable: time from sugammadex to tof ratio &gt; 0,9 (seconds). Secondary variables: time to tof ratio&gt; 0.8, time to tof ratio&gt; 0.7 (seconds), time to maximum block (onset time), intubation conditions (scored valued), surgery time (minutes), changes in qtc interval, sato2 (%) and respiratory rate (rpm) in the first two hours after administration of sugammadex.  the quality of recovery was measured by clinical tests, recurrence of nmb (defined as a tof ratio &lt; 0.9), continuous ecg recording (holter) and specific post-operative quality recovery scale (pqrs) filled 15 minutes and  two hours after administering sugammadex.  for calculating the required sample size estimating an expected maximum time difference in reaching a tof &gt; 0.9, between groups, 120 seconds, with an error of probability type i (? = 0.05), type ii error probability (\u00edY = 0.10) and a 90% power (1-\u00edY), with a maximum standard deviation of 130 seconds, yielding results in a sample of at least 18 patients. The data were treated with the ssps vs 17, levene&apos;s test was used to test the homogeneity of variances. To compare the means of both groups the student t test for independent samples was used. Data were expressed as mean (standard deviation [max-min]), considered significant at p &lt;0.05.  all patients completed the study. There were no significant differences between groups with respect to age, sex, height or surgery time. The weight in tg:  66 (10 [45-79]) was lower than in cg:  73 (13 [52 &#8211; 96]) kg   (* p &lt; 0.05). All patients in tg were on dialysis at least three months before. The mean time of dialysis was 55.1 (31.1 [17-132]) months. The cl cr was significantly lower in tg: 9.7 (4.1 [4.2-19.5]) vs the cg 126 (34[75-188]) ml.Min-1 (*p&lt;0.05). onset time and intubation conditions were not significantly different between groups.   the main variable: time to reach a tof &gt;0.9 in tg: 315 (190 [33-668]),   was significantly higher (*p &lt;0.05) than in ct group: 165 (79 [63-382] seconds.  neither drug-related adverse events nor clinical or monitoring evidence of residual paralysis, recurrence of nmb, or changes in cardiac repolarization was observed in any patient.  sugammadex 4 mg\/kg allows complete, safety and rapid recovery from deep nmb without adverse events in patients with esrd at the end of surgery for renal transplantation.                                   palabras clave:  sugammadex. Reversi\u00f3n bloqueo neuromuscular profundo. trasplante renal. Enfermedad renal terminal. Antagonismo.  seguridad reversi\u00f3n funci\u00f3n neuromuscular.  Aceleromiograf\u00eda.  evaluaci\u00f3n segmento qt.   eficacia de sugammadex en la reversi\u00f3n del bloqueo neuromuscular profundo inducido por rocuronio en pacientes con enfermedad renal terminal sometidos a trasplante renal.   sugammadex antagoniza el bloqueo neuromuscular (bnm) inducido por rocuronio, encapsulando las mol\u00e9culas de rocuronio en  plasma originando un complejo que se excreta principalmente por los ri\u00f1ones. Nuestro objetivo es comparar la eficacia y seguridad de sugammadex en la reversi\u00f3n del bnm profundo, despu\u00e9s de cirug\u00eda para  trasplante renal en pacientes con enfermedad renal terminal (ert) y compararlo con pacientes con funci\u00f3n renal normal.  estudio multic\u00e9ntrico, prospectivo, aleatorizado, grupos paralelos con  reclutamiento competitivo. Se seleccionaron de forma consecutiva veinte pacientes con ert programados para  trasplante renal de donante cad\u00e1ver (gt) y veinte controles con funci\u00f3n renal normal (cg).  anestesia: propofol tci, remifentanyl, rocuronio para mantener un nivel de bnm profundo (ptc&lt;3) durante todo el procedimiento, medido por aceleromiograf\u00eda (tof watch). Sugammadex 4 mg \/ kg al finalizar sutura de piel   variable de eficacia primaria: tiempo desde sugammadex hasta alcanzar  tof ratio &gt; 0,9 (segundos). Variables secundarias: tiempo hasta tof ratio  &gt; 0,8, tiempo hasta tof &gt; 0,7, tiempo hasta obtener bloqueo m\u00e1ximo (onset time), condiciones de intubaci\u00f3n (escala), tiempo quir\u00fargico (minutos). Los cambios en intervalo qtc (holter), sato2, frecuencia respiratoria y otros signos cl\u00ednicos se midieron de forma continua  durante las dos horas siguientes de  administrar sugammadex   la calidad de recuperaci\u00f3n se midi\u00f3 mediante pruebas cl\u00ednicas,  recurrencia de bnm (definida como un valor de tof &lt; 0,9), ecg continuo (holter) y por medio de una escala de recuperaci\u00f3n  (pqrs) 15 minutos y dos horas despu\u00e9s de  administrar sugammadex.  para calcular el tama\u00f1o de muestra, estimando una diferencia m\u00e1xima previsible del tiempo en alcanzar un tof &gt; 0.9 entre grupos, de 120 segundos, con error de probabilidad tipo i, (?= 0.05), probabilidad de error tipo ii (\u00edY= 0.10) y potencia del 90% (1-\u00edY), con desviaci\u00f3n est\u00e1ndar m\u00e1xima de 130 segundos, se necesita una muestra de al menos de 18 pacientes. Los datos se trataron con el ssps vs 17, se utiliz\u00f3 test de levene para comprobar la homogeneidad de varianzas. Para comparar las medias se utiliz\u00f3 la t de student para muestras independientes. Los datos se expresan como media (desviaci\u00f3n est\u00e1ndar [max- min]), considerado significativo valores de p &lt; 0,05.  todos los pacientes completaron el estudio. No hubo diferencias significativas entre grupos con respecto a edad, sexo, altura o tiempo de duraci\u00f3n de la cirug\u00eda. El peso en el gt: 66 (10 [45-79]) fue menor que en el gc: 73 (13 [52-96 ]) kg (p &lt; 0,05) . Todos los pacientes en gt estaban en di\u00e1lisis al menos tres meses antes. El tiempo medio de tratamiento con di\u00e1lisis fue de 55,1 (31,1 [17-132]) meses. El cl cr fue significativamente menor en gt: 9,7 (4,1 [4,2 a 19,5] ) vs en gc: 126 ( 34 [75-188] ) ml.Min &#8211; 1 ( * p &lt; 0,05 ). El onset time y las condiciones de intubaci\u00f3n no fueron significativamente diferentes entre grupos.  la variable principal: tiempo hasta alcanzar un tof &gt; 0,9 en  gt: 315 (190 [33-668]) segundos, fue significativamente mayor (* p &lt; 0,05) que en el gc: 165 (79 [63-382].  no se registraron eventos adversos relacionados con el f\u00e1rmaco ni evidencia cl\u00ednica ni monitorizada de par\u00e1lisis residual, recurrencia de bnm, o cambios en la repolarizaci\u00f3n cardiaca en ning\u00fan paciente.  sugammadex 4 mg\/kg permite una reversi\u00f3n completa, r\u00e1pida y segura del bnm profundo y sin eventos adversos en pacientes con enfermedad renal terminal al final de la cirug\u00eda para el trasplante renal.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Eficacia de sugammadex en la reversi\u00f3n profunda del bloqueo neuromuscular inducido por rocuronio en pacientes con enfermedad renal terminal sometidos a trasplante renal<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Eficacia de sugammadex en la reversi\u00f3n profunda del bloqueo neuromuscular inducido por rocuronio en pacientes con enfermedad renal terminal sometidos a trasplante renal <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Natalia Navarro Garcia <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 02\/05\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Jos\u00e9 Antonio Alvarez Gomez<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: fernando Gilsanz rodr\u00edguez <\/li>\n<li>Mar\u00eda Elena Estell\u00e9s montesinos (vocal)<\/li>\n<li>Juli\u00e1n \u00e1lvarez escudero (vocal)<\/li>\n<li>joaquin Hernandez palazon (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Natalia Navarro Garcia Key words: sugammadex. Reversal profound neuromuscular blockade. renal transplantation. End stage renal disease. Antagonism. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[1569,10,8235],"tags":[30129,25037,138974,2775,228579,228578],"class_list":["post-115586","post","type-post","status-publish","format-standard","hentry","category-anestesiologia-quirurgica","category-cirugia-de-trasplantes","category-murcia","tag-fernando-gilsanz-rodriguez","tag-joaquin-hernandez-palazon","tag-jose-antonio-alvarez-gomez","tag-julian-alvarez-escudero","tag-maria-elena-estelles-montesinos","tag-natalia-navarro-garcia"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/115586","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=115586"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/115586\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=115586"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=115586"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=115586"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}