Antibiotics Affect Rocuronium-induced Neuromuscular Block In Patients Undergoing Painless Bronchoscope Diagnosis And Treatment

BackgroundWith the development of comfort diagnosis and treatment,painless bronchoscope is widely used in clinic,and general anesthesia with laryngeal mask is a common method of anesthesia.Patients with pulmonary infection often need to be treated with antibiotics before the surgery.With the wide application of antibiotics in clinic,the occurrence of side effects of antibiotics has been paid more and more attention.The manifestations of these interactions and their severity depend on the antibiotics and the organ system involved.One of the most important side effects of antibiotics of concern to the anesthesiologist is the action of these drugs on the neuromuscular system.Previous studies have confirmed that many antibiotics can enhance the effect of muscle relaxants,and in animal experiments,it has been found that the use of large doses of some antibiotics can enhance muscle relaxation.Quinolone antibiotics are synthetic antibiotics developed rapidly in recent years,which have the characteristics of wide antibacterial spectrum,strong antibacterial activity,simple structure,convenient administration and so on.They are widely used in the treatment of various bacterial infections.Rocuronium is a commonly used non-depolarizing neuromuscular blocker in clinic.Rocuronium has no significant effect on cardiovascular system,no histamine release and no obvious accumulation after repeated administration.The pharmacodynamics of rocuronium is affected by many factors,such as age,sex,race,temperature,body fat rate,liver and kidney function,concomitant diseases,mode of administration and combination of drugs.In animal and in vitro experiments,fluoroquinolones showed dose-dependent neuromuscular blockade function,and studies have also shown that fluoroquinolones can aggravate the symptoms of patients with myasthenia gravis.However,the effects of fluoroquinolones on rocuronium muscle relaxation and the interaction between fluoroquinolones and rocuronium on neuromuscular block have not been reported.ObjectiveTo measure the interaction of levofloxacin and ceftazidime on neuromuscular blockade induced by rocuronium bromide.To investigate the possible mechanism of neuromuscular blocking activity of fluoroquinolones by observing the effect of preoperative levofloxacin application on neuromuscular blockade of rocuronium,for guiding clinical practice and reducing or avoiding adverse reactions of drug interaction.Methods60 patients undergoing painless bronchoscope diagnosis and treatment,gender unlimited,BMI 20?30kg?m²,ASA grade?to?,Mallampati grade?or?,with normal kidney and liver function,no history of tuberculosis or neuromuscular disease,no chemotherapy history of tumor diseases,taking no medication affecting neuromuscular junction conduction function within the past month.According to age,patients were divided into two groups?n=30?:group A was young and middle-aged group?age 18-64?,group B was elderly group?age>64?.According to the preoperative antibiotics,groups A and groups B were divided into three subgroups respectively?n=10?:levofloxacin group?group??,ceftazidime group?group??and non-antibiotics group?group??.Group of A?was young and middle-aged who treated with levofloxacin?n=10?,group of B?was elderly group of levofloxacin?n=10?,A?was for young and middle-aged group of ceftazidime?n=10?,B?was for elderly group of ceftazidime?n=10?,group A?was young and middle-aged group without antibiotic treatment?n=10?,group B?was the elderly group without without antibiotic treatment?n=10?.Patients in group?and group?were treated with levofloxacin and ceftazidime for 3 days or more before operation respectively,and the regimens were as follows:group?0.6 g of levofloxacin hydrochloride injection by intravenous injection once a day,and group?,3 g of ceftazidime by intravenous injection twice a day.The last time of antibiotic administration before operation was between24 to 30 hours.After entering the operation room,the peripheral venous access was established,and the blood pressure,heart rate,pulse oximetry and electrocardiogram were monitored routinely.Intravenous induction:midazolam 0.03 mg/kg,sufentanil 0.2?g/kg,propofol 2?4 mg/kg were injected intravenously.After the patient fell asleep,the muscle relaxation was monitored by TOF-Watch-SX?Organon Teknika Company,Holland?.The electrodes are placed over the ulnar nerve on the volar side of the wrist.The distal electrode is positioned where the proximal bending line crosses the radial side of the flexor carpi ulnaris muscle.The proximal electrode can be placed 2 to 3 cm proximal of the distal electrode.The transducer should be placed with its largest flat side against the thumb,the temperature sensor was pasted on the medial thenar of the palm,The arm,used for the acceleration measurement,kept warm and immobile during the whole procedure.TOF modes were used,the stimulation intensity was 50 m A,the frequency was 2 Hz,the pulse width was 0.2 ms,the pulse spacing was 500 ms,and the stimulation interval was 12 s.The height of the first twitch response to the TOF was stabilized at 100%±10%as the base value?Tc?.Muscle relaxation monitor automatically calibrated continuous stimulation for 1 min after intravenous injection of rocuronium 0.6 mg/kg.When the TOF ratio was less than or equal to 2,perform laryngeal mask implantation and mechanical ventilation,set tidal volume 6?8 ml/kg,ventilation frequency 12-18 times per minute,I:E is 1:1-1:2,inhaled oxygen concentration 50%?100%,inhaled oxygen flow rate is 2 L/min,maintaining P_ETCO₂30?45 mm Hg?1mm Hg=0.133 k Pa?.Anesthesia maintenance:intravenous infusion of propofol 4?8 mg kg^-1min^-1and remifentanil 0.2?0.5?g kg^-1min^-1.During the operation,the fluctuation of blood pressure and heart rate did not exceed 20%of the basic level.There was no additional muscle relaxant during the operation and no muscle relaxant antagonism was given after operation.The indicators monitored during the operation include:?1?basic information of the patient:gender,age,BMI,ASA classification,the concentrations of blood potassium and sodium,the concentrations of total plasma protein and plasma albumin and operation time;?2?neuromuscular function monitoring:Onset time,unresponsive time,clinical effect time,75%recovery time and recovery index;?3?the occurrence of body movements,cough,intraoperative awareness and muscle insufficiency during surgery.Results?1?In addition to the differences in age,the six groups of patients had no statistically significant differences in general condition and operation time.?P>0.05?;?2?In the same antibiotic treatment group,compared with group A,the onset time of group B decreased,while the unresponsive time,clinical effect time,75%recovery time and recovery index increased?P<0.05?.;?3?Compared with group A?,the onset time of group A?decreased,while the unresponsive time,clinical effect time,75%recovery time and recovery index increased?P<0.05?;there was no significant difference in the pharmacodynamic of rocuronium in group A??P>0.05?.Compared with group B?,the onset time of group B?decreased,while the unresponsive time,clinical effect time,75%recovery time and recovery index increased?P<0.05?;there was no significant difference in the pharmacodynamic of rocuronium in group B??P>0.05?;?4?The variability of B?was significantly greater compared with A?for the same antibiotic treatments;?5?All the patients has no body movements,cough,intraoperative awareness and muscle insufficiency during surgery?P>0.05?.Conclusion?1?One of the influencing factors of rocuronium bromide pharmacodynamics is age.The pharmacodynamics of rocuronium bromide in the elderly is changed,which is characterized by the decrease of onset time,the increase of unresponsive time,clinical effect time,75%recovery time and recovery index.?2?Levofloxacin has a neuromuscular blockade function,which can prolong the effect of rocuronium on muscle relaxation,and it has a more significant effect in the elderly.