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The Physical Compatibility of Glycopyrrolate and Rocuronium
Austen L. Weeks DDS, MA,
 John Sotos DDS,
 Bryce Woolsey DDS,
 William M. Johnston MS, PhD, and
 Bryant W. Cornelius DDS, MBA, MPH
Article Category: Research Article
Volume/Issue: Volume 70: Issue 2
Online Publication Date: Jun 28, 2023
DOI: 10.2344/anpr-69-04-02
Page Range: 53 – 57

rocuronium are combined, resulting in the formation of a precipitate due to discordant differences in pH. 3 Glycopyrrolate, an anticholinergic agent, and rocuronium, a nondepolarizing neuromuscular blocking agent, are 2 drugs commonly used during general anesthesia although usually not concurrently as glycopyrrolate is used during reversal of rocuronium-induced paralysis. However, coadministration may occur if the anticholinergic effects of glycopyrrolate are indicated independent of rocuronium administration. If the patient's physiologic state (eg, excessive

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Suspected Accidental Infiltration of Rocuronium During General Anesthesia Induction: A Case Report
Yuya Sakurai DDS,
 Makiko Shibuya DDS, PhD,
 Ryuichi Okiji DDS,
 Yuri Hase DDS, PhD,
 Takayuki Hojo DDS, PhD,
 Yukifumi Kimura DDS, PhD, and
 Toshiaki Fujisawa DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 70: Issue 3
Online Publication Date: Oct 18, 2023
DOI: 10.2344/anpr-70-02-01
Page Range: 116 – 119

It is important to consider the potential for localized tissue damage and altered pharmacokinetics whenever a drug intended to be administered intravenously is inadvertently administered extravascularly. Although rocuronium is routinely used during general anesthesia and in intensive care units, the pharmacokinetics of infiltrated rocuronium have not been investigated, and there are few reports on infiltrated rocuronium in the existing literature. 1 – 4 We report a case of suspected rocuronium infiltration during the induction of general

Two Cases of Rocuronium-Induced Anaphylaxis/Anaphylactic Shock Successfully Treated With Sugammadex
Mayumi Hashimoto DDS,
 Aiji Sato (Boku) DDS, PhD,
 Naoko Tachi DDS, PhD,
 Yoko Okumura DDS,
 Kanenori Kadoi DDS,
 Jun Harada MD, PhD, and
 Masahiro Okuda MD, PhD
Article Category: Case Report
Volume/Issue: Volume 66: Issue 3
Online Publication Date: Jan 01, 2019
DOI: 10.2344/anpr-66-01-07
Page Range: 151 – 155

estimated that there is 1 case for every 6,500 administrations. 2 Rocuronium is thought to have the highest frequency of allergic reactions. 3 We report 2 cases of anaphylaxis/anaphylactic shock believed to be induced by rocuronium, in which anaphylactic symptoms disappeared following administration of sugammadex and for which remission was achieved without further complications. In preparing this report, written consent for this publication was obtained from the patient herself (case 1) and from the patient and her parents (case 2

Oral Mucosal Injection of a Local Anesthetic Solution Containing Epinephrine Enhances Muscle Relaxant Effects of Rocuronium
Asako Ninomiya DDS,
 Yui Terakawa DDS, PhD,
 Nobuyuki Matsuura DDS, PhD,
 Tatsuya Ichinohe DDS, PhD, and
 Yuzuru Kaneko DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 59: Issue 1
Online Publication Date: Jan 01, 2012
DOI: 10.2344/10-17.1
Page Range: 18 – 21

demonstrate higher plasma concentrations than during conscious condition. 10 , 11 It is therefore suggested that these drugs may affect the muscle relaxant effects. In this study, we investigated the effect of regional administration of clinically relevant doses of lidocaine hydrochloride solution containing epinephrine on the muscle relaxant effects of rocuronium bromide. METHODS Subjects comprised 16 patients scheduled for orthognathic surgery, aged 17–36 years and classified in the American Society of Anesthesiologists (ASA) physical status I

A Case of Rocuronium-Induced Anaphylactic Shock in an Asthmatic Child
Ryuichiro Tanoue PhD, DDS,
 Yusuke Takei DDS,
 Yu Hayashida DDS, and
 Hideki Harada , PhD, MD
Article Category: Brief Report
Volume/Issue: Volume 65: Issue 1
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-64-03-04
Page Range: 58 – 59

The patient was a 7-year-old boy with asthma and allergies to egg and dairy. A slow inhalation induction was initiated in preparation for removal of an odontoma under general anesthesia. During the initial administration of anesthesia, we were able to maintain ventilation. However, ventilation difficulty, decreased blood pressure, and tachycardia occurred immediately after the administration of rocuronium. During direct laryngoscopy via standard laryngoscope, hypopharyngeal or glottic edema was not noted. We suspected an asthma attack, and

Figure.; pH values over time. Mean and 95% confidence limits of pH values of each test group over the times tested. G, glycopyrrolate; R, rocuronium; G&R, glycopyrrolate and rocuronium; R&K, rocuronium and ketorolac; R&L, rocuronium and lidocaine; TTu, test tube; IVT, intravenous tubing; Syr, syringe.
Austen L. Weeks,
 John Sotos,
 Bryce Woolsey,
 William M. Johnston, and
 Bryant W. Cornelius
Figure.
Figure.

pH values over time.

Mean and 95% confidence limits of pH values of each test group over the times tested. G, glycopyrrolate; R, rocuronium; G&R, glycopyrrolate and rocuronium; R&K, rocuronium and ketorolac; R&L, rocuronium and lidocaine; TTu, test tube; IVT, intravenous tubing; Syr, syringe.

Potentiation of Rocuronium Bromide by Lithium Carbonate: A Case Report
Naotaka Kishimoto DDS, PhD,
 Hiroyuki Yoshikawa DDS, PhD, and
 Kenji Seo DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 67: Issue 3
Online Publication Date: Sep 29, 2020
DOI: 10.2344/anpr-66-04-04
Page Range: 146 – 150

is unclear. 1 , 2 Previously reported anesthetic concerns in patients taking lithium include the occurrence of lithium toxicity accompanying an inadequate perioperative fluid volume, potentiation of the effects of barbiturate anesthesia, and electrocardiogram changes. 2 Of particular clinical concern is the potentiation of muscle relaxants by lithium. Lithium reportedly potentiates both depolarizing 3 and nondepolarizing muscle relaxants. 4 , 5 The present report describes the case of potentiation and prolongation of rocuronium bromide after oral and

Sugammadex: Efficacy and Practicality in the Dental Office
Stephen Goetz DMD,
 Benjamin Pritts DMD, and
 Bryant Cornelius. DDS MBA, MPH
Article Category: Research Article
Volume/Issue: Volume 65: Issue 2
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-03-03
Page Range: 113 – 118

(Bridion) for the reversal of neuromuscular blockade induced by rocuronium or vecuronium. Sugammadex is a gamma cyclodextrin ring made up of 8 conjoined sugar molecules. It works by encapsulating a neuromuscular blocking drug (NMBD) in a 1:1 ratio. This encapsulation of the NMBD by sugammadex renders the NMBD unable to bind to acetylcholine nicotinic receptors. As plasma levels of the NMBD decrease, a rapid shift in the concentration gradient causes remaining NMBD to diffuse away from the neuromuscular junction. If enough sugammadex is used, a complete reversal of

Figure 4.; Skin Prick and Basophil Activation Tests Example of a skin prick test: 1. normal saline (negative control), 2. histamine (positive control), 3. fentanyl, 4. remifentanil, 5. atropine, 6. piperacillin, 7. propofol, and 8. rocuronium. All skin prick tests showed negative results. Intradermal skin test for rocuronium showed positive result at 10-fold dilution (15 minutes later, wheal: 5 × 7 mm; erythema: 25 × 22 mm). Basophil activation test showed that rocuronium and flomoxef were negative results, and a rubber dam sheet was a positive result.
Takashi Goto
Figure 4.
Figure 4.

Skin Prick and Basophil Activation Tests

Example of a skin prick test: 1. normal saline (negative control), 2. histamine (positive control), 3. fentanyl, 4. remifentanil, 5. atropine, 6. piperacillin, 7. propofol, and 8. rocuronium. All skin prick tests showed negative results. Intradermal skin test for rocuronium showed positive result at 10-fold dilution (15 minutes later, wheal: 5 × 7 mm; erythema: 25 × 22 mm). Basophil activation test showed that rocuronium and flomoxef were negative results, and a rubber dam sheet was a positive result.