Chemotherapy alters cisatracurium induced neuromuscular blockade characteristics: A prospective cohort study.
OBJECTIVE
To compare the characteristics of NMDR induced muscle paralysis in breast cancer patients with and without a history of recent chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) regimen.


METHODS
This is a non-randomized prospective cohort study.


METHODS
Operating room of a university-affiliated teaching hospital.


METHODS
Out of a total of 50 patients who had undergone mastectomy, 22 patients were allocated to the "Chemo group" and 28 patients to the "Non-Chemo group", based on a valid history of recent chemotherapy.


METHODS
After induction of anesthesia with thiopental and cisatracurium, neuromuscular monitoring was started for all patients.


METHODS
Initially the time to 100% single-twitch (ST) suppression was measured. Then, the time for the appearance of the first response to post-tetanic count (PTC) stimulation, Train-of-Four (TOF) stimulation, and TOF50%were measured consequently.


RESULTS
Time to get STzerowas significantly longer in the Chemo group than in the Non-chemo group. Time for the appearance of the first response of PTC and TOF and TOF50%was significantly shorter in the Chemo group than the other group. The mean duration of intense block was 27.66 minutes in the Chemo group versus 42.47 minutes in the Non-chemo group.


CONCLUSIONS
This research demonstrated that in patients having undergone chemotherapy, the effect of NDMRs starts with a longer lag time and finishes earlier too. Thus, these patients are ready for intubation after a longer time. Moreover, we have to repeat cisatracurium injections after shorter intervals to maintain the desired level of blockade.
Tehran University of Medical Sciences, Assistant Professor, Dept. of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran. Electronic address: p_zanjani@yahoo.com.
Amir Poya
AP
Zanjani
Tehran University of Medical Sciences, Assistant Professor, Dept. of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran. Electronic address: maziarmdaa@yahoo.com.
Maziar
M
Maghsoudloo
Tehran University of Medical Sciences, Assistant Professor, Dept. of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran. Electronic address: makaremj@yahoo.com.
Jalil
J
Makarem
Tehran University of Medical Sciences, Professor, Dept. of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran. Electronic address: farrokhnia1503@yahoo.com.
Fahimeh
F
Farokhnia
Tehran University of Medical Sciences, Dept. of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran. Electronic address: ghadikolahi@gmail.com.
Morteza
M
Fazli
Tehran University of Medical Sciences, Professor, Dept. of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran. Electronic address: Khanzh51@yahoo.com.
Zahid Hussain
ZH
Khan
D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology*; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors / Q000494:pharmacology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000494:pharmacology; D004317:Doxorubicin / Q000494:pharmacology; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000494:pharmacology; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D020360:Neoadjuvant Therapy / Q000379:methods; D019148:Neuromuscular Blockade / Q000379:methods*; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D011446:Prospective Studies
D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D004317:Doxorubicin; D003520:Cyclophosphamide; C101584:cisatracurium; D005472:Fluorouracil
Chemotherapy; Cisatracurium; Doxorubicin; General anesthesia; Neuromuscular blocking agents